By Earl R. Carlson, MD

Because I have felt so much the meaning of this book I may
be excused for claiming the privilege, not often given to the publisher, of
writing an introduction.

If only spastics, or only cripples, would find hope in
these pages, one might regard the story as worth telling but still rather
special. But it seems to me far more than that. It is a story for anyone who
is under a handicap of any kind, those who are deaf or blind or ill, those who
are tired and worn or “nervous,” and even those who feel themselves beaten by
society, by economic conditions, or by what they think is some failure in
themselves. To all such, and even to the physically strong and the mentally
confident, Dr. Carlson has far more to say than he himself can possibly realize.

He was born in a poor home and was so injured at birth that
it was years before he could control his legs or arms or even the organs of
speech. Unlike most of us who learned these controls in infancy, he can still
recall vividly his first success in reaching out his hand and taking what he
wanted – it happened to be an apple he was stealing – and the greater excitement
of his first unaided steps. Determined to get an education, he crept out into
the world and somehow found work he was able to do. He found generous persons
who helped him and became his friends, and though both his parents died while he
was in college, he struggled on until, more than eleven years later, he took at
Yale Medical School his degree as a physician. Today he is a famous specialist
in the very field of his own injuries, and the parents of many thousands of
spastic cripples turn to him for advice and treatment.

With calm candor he tells his own experience, hiding
nothing and priding himself on nothing. He tells also of many other cases, more
or less like his own, which have come under his eye. He tells what the parents’
approach and what society’s approach should be and how the handicapped
individual, as he grows up, can and should face the world.

When one considers that this comes from a man who, long
after he was full-grown, never knew when he picked up a cup of coffee whether it
would reach his mouth or fly over his shoulder, one cannot but marvel at the
triumph possible when human will power, intelligence, and courage combine.
Gradually one comes to see that what this man had to deal with were, was one
reader has said, simply the common usual human problems terrible intensified –
fear of failure, fear of being pitied or laughed at, insecurity, and the
constant hard task of mastering, training, and drilling the body, the mind and
the spirit. And one gladly discovers that his own conclusion is that every
human life, however handicapped, has its purpose and can be of use.

Richard J. Walsh

This book would never have been written if my entrance into
the world had been as simple and dramatic as my mother’s.

Years ago, in Veberod in southern Sweden, a hearty
countrywoman sat out in her farmyard doing the evening milking. Suddenly she
stopped work and stared to her feet; and without further ado was delivered of
her seventh daughter, who landed in the milk pail. My grandmother secured the
child from this impromptu baptism, took it back to the house and cared for it,
and then went on about her household duties.

With such sturdy ancestry and her own robust heath, my
mother, Margaret Anderson, had little reason to anticipate any difficulty in
childbearing. Nor was there a poor physical heritage on my father’s side of the
family. The Carlsons were a robust tribe in Northern Sweden, and his strength
and endurance were such that he was able to do the hardest sort on manual labor
all his life. He came to America as a stowaway when he was sixteen years old,
and some years later found his wife in one of the many Scandinavian colonies
which sprang up in the Great Lakes region. Like many other immigrants, my
parents found no pot of gold awaiting them in the promised land of America; and
in 1897, the year of my birth, they were living in a tiny e poorer
section of Minneapolis. My father worked as a factory stoker, with only a
half-day’s holiday every other week. His wages, eked out by my mother’s
earnings as a seamstress, gave them only a bare living.

On March 25, 1897, Minneapolis suffered the worst blizzard
of that notably hard winter. Our little house, buddle between a livery stable
and a church, was almost buried in the snow, which had drifted high above the
window sills. All over the city, streets and sidewalks were blocked and
transportation was at a standstill. At the height of the storm my mother’s
labor began. The doctor was long delayed by the blizzard, and found her in
critical condition when at last he arrived. He was obliged to use forceps in
order to save her life, and I came into the world with a damaged left eye, which
remained closed for weeks, and other head injuries. I still bear the scar of
the forceps on my head. It was a closed call, for I was born blue and
breathless, and my life was saved on by the doctor’s blowing his own breath into
my lungs. I was unable to nurse for several days and had to be given mild
through a medicine dropper. In later life, as I sometimes despaired in the
struggle against my handicaps, I often wondered whether that doctor should have
saved a child that he knew could not be normal. For these birth injuries made
me a victim of spastic and athetoid paralysis. I did not have a loss of motion
such as is encountered in infantile paralysis, but rather an exaggerated
motion. My arm would wander aimlessly, and the hand in attempts to g rasp an
object would remain fixed in that position and was relaxed with difficulty.
When I was supported under the arm, the legs had a tendency to cross, and I
could not bring the heels to the floor. Swallowing was difficult because I
gagged easily. I spent a large amount of nervous energy in attempts to move a
single muscle group, and often the mere thought of moving a finger was
sufficient to throw the entire body musculature into a chaos of writhing
movements. When I was not afraid, self-conscious, or aver anxious about what I
was doing, I was able to make a movement successfully. But this happened only
when I was so absorbed in what I was doing that I forgot about the things I did
badly.

My parents were not without hope for me, despite the
doctor’s blunt warning that the head injuries I had received would prevent me
from ever developing into a normal child. My eye healed, and I seemed to grow
like any other infant. I weighed twenty-five pounds when I was six months old;
but, unlike the normal baby of this age, I could not sit up without help. In
the family album there is a picture of me taken at this time, a chubby,
wide-eyed infant, surrounded by the billowing skirts which helped to conceal my
mother’s supporting hands. She had just noticed that I could not use the
muscles of by back properly. Later, when I failed to learn to walk and talk at
the usual ages, my mother realized that I was going to be seriously
handicapped. But she continued to hope that my development was retarded, rather
than seriously restricted, by the injuries I had suffered at birth.

This hope seemed to be partially realized when I began to
crawl at the age of two. I soon became so energetic that I was constantly
getting into trouble, and I acquired hard calluses on my hands and knees. For a
time my mother pared these with a razor, just as you would cut down a horse’s
hoofs; but then she hit upon the expedient of making little leather pads for me
to get about on. For years I failed to progress from the crawling to the
toddling stage, but nevertheless I managed to cover a surprising amount of
ground. One of my earliest recollections is of how I distinguished myself by
crawling into a neighbor’s garden-my family had moved from Minneapolis to the
small town of Geneva, Illinois-and stealing some peas that had attracted my
attention. My mother scolded me severely for this exploit, but she nevertheless
regarded it as a major achievement since I had previously been unable to do
anything at all for myself. I now know that it was the irresistible attraction
that those peas held for me and the resulting complete preoccupation with my
purpose that made this act possible for me.

In a year or two my family returned to Minneapolis to take
advantage of a better job that came my father’s way. We had a two-room flat in
a red tenement, which was on the same street as a big brewery. Mother tried to
teach me to wald by supporting my shoulders from behind as I tottered up and
down the street. Sometimes she sat down on a bench to rest and to have a chat
with her friend, Mrs. Gibson, who was always loudly pitying me and telling my
mother that she had the patience of Job. Mrs. Gibson had the notion that my
physical handicaps were accompanied by mental ones-since she thought that I was
mentally defective, she did not hesitate to talk freely in front of me. In
fact, all the neighbors were anxious to know what was wrong with me, and held
various theories involving “bad blood’ and prenatal influences which they often
aired to Mother when I was about. Mother always tried to prevent me from
hearing these conversations, but hear them I did; and her stock answer, that I
was “just born that way,” stuck in my mind. I sometimes wondered why I was an
object of pity; I had no idea that I was abnormal-it was all natural enough
since I was “born that way.”

There was more wisdom in my mother’s answer to the
neighbor’s questions than perhaps she realized. At birth every baby is without
physical or mental control. His movements are uncoordinated and more or less at
random. At birth the brain is unable to function properly, to select the
revalant impulses from among the sensory impressions which bombard the nervous
system, and to translate them into the purposeful action. Until this selective
capacity develops with the growth of the cortex, the child grimaces and drools
and wiggles quite unconsciously. He is unable to focus his attention upon any
one object; he will pick up a toy only to reject me for another the following
moment. His motions are without purpose. As intelligence develops and
concentration on a purpose is achieved, these aimless movements and reactions
cease. Certain structural and chemical elements in the brain grow as use is
made of them. This is particularly true of the substance which insulates the
nerve fibers. The insulating material is least in amount at birth, when
muscular control is at its minimum. It increases noticeably at the end of the
first year at the time when speech and walking occur. It shows marked additions
in adolescence as more connections are made between nerve fibers to facilitate
the youth’s ability to classify the knowledge to which he has been exposed in
childhood. Before this insulation is built up, the nervous system of the brain
is like a switchboard with crossed wires, and the impulses often bring the wrong
muscles into action. Spastic children do not develop concentration and
selective ability naturally; the wires remain crossed and involuntary movements
continue. Training is therefore even more important for the spastic than for
the normal child; by education it is possible to develop unaffected centers of
the brain, and a corresponding improvement of the damaged controls can be
effected. The importance of concentration is evident in my ability to get at
our neighbor’s peas when my whole attention was set upon them, though otherwise
it would have been impossible for me to reach them. I was born with certain
motor activities impaired, but I could control these activities when my brain was
dominated by an impulse which demanded their use.

I recall another incident in my childhood which shows how
concentration makes the impossible possible. My uncle had a farm some sixty
miles from Minneapolis, where my mother often took me for long visits during the
summer. Father used to walk out from Minneapolis to see us, since he could not
afford train fare. There were some cousins of mine from Chicago who also spent
their summers at the farm. One day, when I was about four, they went off into
the woods, searching for cleft branches out of which they could make
slingshots. Not wanting to be left out of anything that was going on, I crawled
after them on my hands and knees and returned home dragging a branch. I showed
it to my mother and told her that we could make two canes out of it, so that I
could walk like my cousins. My father carved the canes out of that branch, and
I used them when I first began to walk. Long after they had been discarded as
unnecessary aids, my mother kept them as evidence of my initiative in meeting
the problem of my handicaps.

Another adventure at my uncle’s farm is still very vivid in
my memory. I was crawling along in his orchard in search of apples and plums
which had fallen to the ground, when, in trying to reach a piece of fruit, I
leaned against a beehive. The bees swarmed all over me, and in my overpowering
desire to get away from their stings I managed to take a few steps, though I had
not yet learned to walk, before falling to the ground. My uncle heard my cries
and rushed to the rescue, but he was not in time to same me from being terribly
stung. It has recently been discovered that injections of bee and snake venom
produce a temporary alleviation of spasticity. But I was too young at the time
to recall now whether this accident brought about any improvement in my
condition. My ability to take those few steps may have been the result of
concentration on escaping or have been caused by the therapeutic effect of the
stings.

I learned to take my first intentional steps at home in a
curious fashion. My mother bought a sewing machine, which came in a large
wooden crate, a mile long, as I remember it. My father knocked out both ends,
so that its sides formed a pair of parallel bars on which I could support myself
as I tottered up and down the length of the box. That was when I was five and a
half years old; the normal child begins to walk soon after his first birthday.
Some of the delay in my learning to walk by myself was my mother’s fault, I had
become so used to her support from behind that, when I tried to walk alone, I
was tormented by a fear of falling backwards. Many spastic children acquire
this fear in the same way that I did; and in my practice today I overcome it by
having them push a baby carriage as they learn to walk, which develops the sense
of balance far better than support and guidance from the rear. Then when they
try walking by themselves they will not stumble along blindly as I did; for,
relying on my mother’s guidance, I had never formed the habit of looking where I
was going.

Though my family’s poverty meant many deprivations, I have
never regretted it, because it saved me from the sheltered life which would have
made the conquest of my handicaps all the more difficult. If my family had been
well-to-do, I would probably have been kept from contact with normal children,
and the result would have been a withdrawal into a world of introspection and
daydreams, and an increasing maladjustment to everyday life. Play-life is
essential for sound emotional development, which is vitally important to the
spastic. The children of the poor cannot be sheltered from life and from
association with their fellows, and I shall always be grateful that I was not
deprived of a few firm friendships which I formed early n life and which still
endure.

When I was three my friendship with Harold began. He was a
tall, handsome boy, but shy and introspective in nature, perhaps that is why he
sought my company. Despite my inability to walk my aimlessly jerking arms, and
my speech difficulties, I was something of a chatterbox and full of notions. As
we grew older I devised stunts for his sound legs and arms to carry out. It was
a partnership in which I was the brain and he was the body. And best of all, I
somehow knew that Harold’s friendship for me was not motivated by pity or his
mother’s urging, like that of some of the children, but by real pleasure that he
found in playing with me.

I remember vividly one early exploit of our partnership.
My father had brought home a varnish case from the paint factory where he then
worked, and had contrived out of it a wagon big enough for me to ride in. This
contraption, gaily painted yellow, appealed strongly to my friends, and I had no
trouble getting one of them to pull it and another to push, as I rode in state
around our block. One day Harold, another youngster, and I were making a tour
of the neighborhood when we saw a pile of luscious-looking apples in front of a
fruit stand. The next time we passed the stand I stared at the fruit in
mouth-watering absorption. Before I knew what I was doing, I had stretched out
my hand and grabbed an apple. This bit of petty thievery may seem a poor enough
achievement, but it was the first time that my hand had ever done my bidding.
My friends we delighted by my success, but they wanted apples too, so we
repeated the performance twice. All went well the second time because the fruit
stand was on a busy intersection, and the owner paid no attention to a cripple
being hauled along in a homemade wagon by two youngsters. But the third time he
caught us red-handed. He licked the others then and there; but, since I was a
cripple, he took me home to my mother and told her what I had done. My mother
said that I could not possibly have stolen the fruit, for I could not even feed
myself, but that I certainly had enough of the devil in me to put the other boys
up to it.

She spanked me on general principals, however, and later
asked me whether I had really taken the fruit myself or just suggested the idea
to the others. I answered her soberly, for the spanking had made me realize
that something serious had happened.

“Mother,” I said, “I looked at those apples, and the more I
looked the more I wanted one; and finally I wanted one so much that my hand just
reached out and grabbed it.”

Apples seem to be the fruit of revelation as well as of
temptation. A falling apple suggested the law of gravity to Isaac Newton; my
stolen apples gave me the clue, not followed up for years, that the secret of
control for the muscularly handicapped lies in concentration of a purpose. The
more objective the interest in performing an act, the easier it is to do it.

There was another red-letter incident in my youth which
bore out this truth, if I could but have seen it at that time. I was then just
barely able to get around with the help of the canes my father had made for me;
without them I was completely helpless. Raymond, another good friend of mine,
was much taken by the odd figure I cut as I struggled along on my canes. He
suggested that we ought to play horse, since I had four legs. This seemed like
a good idea, and I submitted to being harnessed up and driven for a while. Then
Raymond’s mother called him into the house, He had the canny notion that I
might be tired of a game which he enjoyed, and he took my canes with him, so
that I couldn’t run away, leaving me leaning helplessly against a house,
Suddenly the noon whistle blew at the brewery across the street. Its shriek
always frightened the magnificent horses which were the pride of Minneapolis as
they drew the big brewery wagons about the city. This time a team ran away, and
I was so excited that I ran away too-I ran a whole block without my canes before
I realized what I was doing. I could walk! It seemed too good to be true, and
I rushed home to tell my mother the great news. I half-ran, half lurched, into
the room where she was having a coffee party with some neighbors, and they all
cried out in amazement: “Your boy walks without his canes! A miracle has
happened; your prayers have been answered!” My mother alone was calm. “No
miracle,” She said calmly. “It’s the result of hard work.”

But my mother was mistaken. All the training she had given
me had helped; but it was my complete preoccupation with the runaway horses and
the overwhelming impulse to join them that had made the impossible happen and
had enabled me to run unaided. It was another instance of the control of the
emotions over ordinarily helpless limbs, just as when I stole the peas and the
apples.

At that time, of course, I could not analyze the incident
rationally, and for many years afterward I beloved that it was a miracle that
had made walking possible for me. Even now, I am not at all sure that prayer
did not have something to do wit hit. Through praying that I might walk, I
achieved that concentration of purpose which is known to produce such seemingly
miraculous results as occurred in my own case. I had inherited a pious bent
from my mother, who was a religious woman. This piety of mine strengthened when
I discovered that my aimless movements ceased when I was absorbed in prayer. In
the prayer meetings that I attended as a child, the ceremony of laying hands on
the afflicted was observed, and often the congregation would be overjoyed by the
miraculous effect this had on me. But the cure was never permanent; what I
might now, as a doctor, call the selective inhibition of irrelevant impulses
lasted only as long as I was absorbed in the spirit of prayer. Later on in my
life I took a passionate interest in Christian Science, hoping to be wholly
cured of my infirmities through its technique of faith healing. But this, like
many other hopes, was never realized.

My mother, for all her piety, was a very practical minded
woman-as, indeed, she had to be in our circumstances. But she enjoyed dabbling
in the supernatural. By age-old superstition, as the seventh daughter of a
family of eleven, she was supposed to have certain psychic powers because of the
occult significance of these numbers. She was in great demand as a reader of
fortunes in coffee grounds or tea leaves, and could easily have made a good deal
of money out of it. But my father, who was a socialist and something of an
atheist, distrusted these dealings in black magic and forbade her to accept any
pay for her performances as a fortuneteller, though he allowed her to amuse
herself at it. Certainly she made some remarkable prophecies as she pretended
to peer into the future, and her rosy predictions doubtless made the hard
present somewhat easier for her friends. I know that she strengthened my
confidence in despairing moments by telling me that things would go well in the
future.

Whether it was through faith in her prayers or in her own
predictions, my mother never gave up hope of my cure. She had no money for
private physicians, but she took me from one clinic to another during my
childhood. None of the doctors that she consulted ever held out any hope for my
physical recover; invariably they assured her that medicine and surgery were
helpless in cases such as mine. But at the clinic of the University of Minnesota
Medical School, they did urge upon her the importance of stimulating my mind by
regular education. It was made plain to her that my mind alone could provide an
escape from my physical handicaps. Yet sometimes she rebelled against this
verdict and tried all manner of quack medicines and healing cults, as well as
chiropractors and osteopaths, who are unable, of course, to deal with such
conditions as mine. Time after time my hopes were raised high and then brought
crashing down, though not always as quickly as upon one occasion when we journey
to Wisconsin to consult a famous healer, only to find that upon the day of our
arrival he had received a prison sentence for practicing medicine illegally.
The failure of these various expedients finally forced my mother to the
conclusion that she had been soundly advised by the clinic doctors.

Most parents of crippled children are chiefly concerned
with restoring physical health. They want above all to have their child able to
run and walk and handle himself like other children. They-and the child-await
the miracle of healing in aate of suspended animation, thus allowing the child
to develop serious emotional maladjustments because he is not subjected to the
same education and disciplinary influences as other children.

Fortunately my mother did not make this common mistake.
She soon discovered that I was happiest and best able to control myself when I
was busily occupied. Actually she had little choice in the matter, because her
hours were so filled with housework and with the sewing which brought badly
needed money into our home that she had no time to spoil me by constant
attention. But I can remember how she told me that I must keep busy and work as
hard as my father did. Like most spastics, I had a tendency to grin al the
time, quite regardless of whether I felt happy or sad. This habit is simply a
matter of lack of control. My father broke me of it by constant rebukes. When
he came home after a long day’s work, and he and mother were constantly worried
about how to keep a roof over our heads, it angered him to find me grinning away
as if we did not have a worry in the world. Since I either go rid of the grin
or got a licking, I soon acquired the self-discipline which was invaluable in
overcoming other difficulties. I had to learn to do as much as I could for
myself, and to depend upon my own resources for amusement.

Today in clinics I treat children whose mothers have no
choice but to leave them alone at home while working. These children must
manage to crawl to the table to get their food and to get to the bathroom
without help. Invariably these underprivileged youngsters improve far more
rapidly under treatment than children from wealthy homes, whose chances to
develop are killed by kindness. The situation becomes more serious as the child
grows older, for the more accustomed he is to getting his own way, the harder it
is for him to adjust to the everyday world. The difficulty experienced by
spastics in obtaining and holding positions is owing to this spoiled-child
attitude rather than to their physical handicaps. I am eternally grateful to
those doctors who urged my mother to concentrate on my mental development rather
than on a physical cure which they deemed impossible. Through my experiences at
school and college, I learned the great truth which governs all those afflicted
as I was: control of motions is won by control of emotions.

But in my childhood I drew no moral from my experiences. I
accepted as a miracle the fact that I was now able to walk unassisted, and I
formed a passionate faith that a still greater miracle would be achieved when I
grew up: that halting feet, shaking head, writhing arms and legs, and troubled
speech would all be healed.

My mother had quite a struggle with the Board of Education
to get me into public school when I was eight years old. In their opinion the
proper place for me was an institution, not a school. Even after the Board’s
consent was won through mother's persistence, the teachers were so alarmed by
my constant twitching that they did their best to have me sent home. The
nervousness caused by the strangeness of this new world into which I was thrust
accentuated my handicaps, and I found it impossible to do many things at school
that were easy for me at home. Mother persuaded the teachers to allow me to
stay at school for two weeks on trial; and as soon as the new environment became
familiar I calmed down considerably, and my instructors withdrew their
objections. But at school I was always conscious of a nervous tension which did
not bother me at home; and, though I soon got along there well enough, I hated
to go.

So I worked on my mother’s sympathy by exaggerating my
handicaps and by seeming to lose all the control that I had slowly built up. At
breakfast I would send cups and plates flying, in the hope that Mother would
decide that I was not well enough to go to school. But she saw through these
maneuvers of mine. After giving me a good scolding and a lecture on how
important education was for me, she would drive me off to school. The same
trouble always arose again whenever I was promoted from one class to another.
For years new faces and strange situations petrified me with fear. I can
remember once playing hooky for a period of some days rather than face the
unpleasantness of getting settled in a new class. Mother gave me a sound
licking when she found out about this escapade, and again made it plain to me
that I had no chance of getting along in the world unless I got a good
education. She hoped that I had taken her words to heart, but she made sure
that I did not fool her again by getting another boy to take me to and from
school.

Even when I had overcome my nervousness, school life was
not easy for me. I constantly had to be helped, for I could not take off my
coat or get to my desk by myself. I was allowed to enter and leave the
classrooms early, in order to avoid the crowds, for I was so unsteady on my legs
that the gentlest push would send me sprawling. Mother arranged with the
janitor to take me to the bathroom, and with one of the older boys to carry me
out and in whenever the fire drills were held-one of the Board of Education’s
chief objections had been that I would present a problem upon these occasions.
Everybody went out of his way to be considerate once he understood my
difficulties, but it seemed to me as if this understanding was hardly
established before a change of teachers or classes made it necessary to start
all over again.

As I approached adolescence, I became so self-conscious
about my handicaps and so introspective that I must have impressed my teachers
as being mentally retarded. For the first time the realization that I was
different from other people sank home. When I saw that none of my schoolmates
were afflicted as I was, I began to wonder if there were some hereditary curse
upon me. I fell into the habit of brooding upon my handicaps, and these seemed
to grow steadily worse. My parents were concerned about me, for now at periods
I lacked any sort of control; and they took me around to the doctors again, who
could do nothing more helpful than prescribe sedatives, which at least helped my
confidence if nothing else. At school I was excused from writing since it was
difficult for me to hold a pencil, and from singing since I had no control of my
voice. This being set apart from the others only increased my sense of
isolation from the rest of mankind. I never went out with the other children at
recess, because if anyone so much as pointed a finger at me I fell down. I
followed back alleys on y way to and from school to avoid being seen. It seemed
to me that everyone I met was talking about and pointing out my handicaps, and
the more self-conscious I became, the harder it was to maintain any sort of
control. I could not understand why it was impossible for me to do certain
things in public which I could manage satisfactorily at home. But the
difficulty was real enough, and in some cases took years to overcome. I could
not eat by myself in public until I was eighteen or nineteen. Now I know that
the more conscious of his handicaps a spastic is, the more difficult it is for
him to overcome them. Thinking of something associated with relaxation, rather
than struggling to overcome the tension, is essential in avoiding difficulty;
and I could not escape self-consciousness except when I was in my home or
absorbed in work.

Since I was physically unable to take part in many of my
schoolmates’ pastimes, and barred from others by the psychological barriers
which I erected myself, I got into the habit of reading a good deal. It was
possible to do this at home, without the ordeal of going to the public library,
through the kindness of one of the boarders Mother had been obliged to take in
when Father was unable to find work during a period of economic depression.
Gustaf Erickson was a college graduate and had several hundred books which he
allowed me to use. He lived with us for fifteen years and soon established
himself as a member of the family. It was to him I turned when father went off
job-hunting in places far from Minneapolis I can remember how Father heard of
work as a harvest hand in the Dakota wheat fields, and how he rode the rods of a
freight train to get there since he had no money for a ticket. Mother and I
were worried about him when two weeks went by without word from him, but Gus
assured us that he would come safely home; and so he did. Gus opened new worlds
to me by talking with me and lending me his books, and I found as much delight
in this way as I derived from the spending money which this kindly soul often
gave me.

Unfortunately one of these books was a health treatise,
which I came upon must as I began to worry about myself. It started me trying
to breathe correctly, and I soon discovered that it was difficult for me to
breathe at all. I developed a diaphragmatic tic, which bothered me whenever I
was nervously excited. When I was called upon to recite in school, I would get
tense at the idea of being the center of attention, my hands and legs would
start shaking uncontrollably, by breath would fail me, and my actual speech
difficulty would be outrageously accentuated. When I put on a show like this,
there was nothing for the appalled teacher to do but get me a glass of water and
send me home to calm down. This trouble afflicted me for months, and I wanted
to give up school because of it. But Mother would not hear of my abandoning the
course she had set for me, so back I went to struggle against this new
complication, which I had brought on myself, an d for spastics are exceptionally
prone to suggestion.

This troubled time in my life was brightened by the
companionship of three faithful friends, Harold, Reynold, and Irving. Playing
with them I forgot my self-consciousness and forgot to worry about myself.
Together we involved ourselves in considerable mischief, and I always resented
any implication, no matter how tacit, that there were things they could do that
I could not. One day they decided to see the world, and rode the streetcar to
the end of the line, which was some miles outside Minneapolis. They came back
full of accounts of the wonders they had seen, and told me what a pity it was
that I couldn’t have gone with them. This was a challenge to me; and, taking a
long-treasured dime, I made a solitary investigation of the city’s
transportation system. When I finally go home at two o’clock in the morning, my
distracted parents had the police searching for me. The licking that I received
was completely eclipsed by the glories in retrospect of that adventure and by
the admiration I won from my friends for daring the unknown by myself.

It was at this time, too, that I made my first efforts to
earn money. I sold newspapers on the streets for a few weeks until my father
found out about it. He discovered, or thought he discovered, that people were
buying their papers from me out of pity; and this he disliked intensely. He
made me give up the job and told me that he could support me without my making
capital of my handicaps. Thus brought up short in my attempt to improve the
family fortunes, I proceeded to sell to our neighbors some of my mother’s
imitation jewelry from the five-and-ten for considerably more than its value.
Mother made me return the money I obtained in this way, although I could not see
why it was not good business to sell a ten-cent pin for a dollar, if you could
find a buyer, no matter what his motives were.

The transition from grade to high school when I was
thirteen proved too much for me. South High had a great many more pupils than
either of the two grammar schools I had attended, and the crowds of strangers
swarming in and out of the classrooms terrified me. There was a bustling,
impersonal air about the place, and no one seemed to have time to pay any
attention to me and my difficulties. After struggling along as best I could by
myself for three or four days, I decided that South High was not the place for
me and stayed home. But I was still anxious to obtain more education, and after
a few weeks of trying to keep up with my friends by going over their lessons
with them and studying in the library at home, I found a better answer to the
problem. During the previous year our eighth grade teacher had taken the whole
class on the streetcar to St. Paul to see the legislature in action. About
halfway between the twin cities we had passed the grounds of a private school
called Bethel Academy. It had struck me as a wonderfully attractive place, and
I asked our teacher about it. I was told that it was a small Baptist
institution which enjoyed a very good academic standing. At that moment was
born the dream that I might some day be a student there; but, like most of my
dreams, I never expected it to be realized. Now, since public high school was
out of the question for me, I thought it worth while to discover whether I could
gain admission to this school which appealed so much to me. They were willing
to take me after they had heard my story; and so, after spending six weeks at
home, I went back to school again.

I felt a good deal more at home at Bethel than I had at
high school. There were only from six to twelve children in each class, and I
soon got to know my schoolmates and teachers. The worst part about the new
arrangement was the long streetcar trip to school and back home again every day,
which could not be avoided, though it was not easy for me. My chief trial at
school was reading aloud in class. I used another book to hold open the one
from which I was reading, since I used my left hand to turn the page and had to
keep my right between my knees in order to control it. When I came to the
bottom of the page, even though it was in the middle of a sentence, I had to
come to a full stop while I attempted to turn the page. The book had a perverse
habit of not staying open during this operation, which always flustered me, and
once I flipped it clear across the classroom in my anxiety to turn the page.
Then when I was trying to recite my hand would start twitching, and when I tried
to control it I would lose the thread of what I was trying to say. But these
difficulties lessened as I grew more accustomed to my new environment. It was
not so long before I was trying to embarrass my schoolmates, rather than being
embarrassed by them. At this time I wore leg braces which extended from my
waist to my ankles. I let them go un-oiled, so that I could squeak them and make
the girls in the class think that there was a mouse in the room.

At bethel I found a way of circumventing my difficulty in
writing. One of my classmates possessed a typewriter, which he allowed me to
use. I found that it was much easier for me to press the keys than to attempt
to hold a pen or pencil. Typewriters were then very much more expensive than
they are now, and a machine of my own was completely out of the question. But
after my friend left Bethel, mother rented a machine for me, and eventually I
got a light typewriter of my own. The development of electric typewriters which
require only the slightest pressure on the key has provided a means of
expression to many spastics who can neither write with a pencil nor speak. And
these machines are a tremendous help to those who can write only slowly, poorly,
or laboriously by hand.

In my studies, I had a good deal of difficulty with
languages, and especially with spelling. But I became very much interested in
science, particularly physics, and won high standing in this subject. During the
summer I took a correspondence-school course in chemistry; and my friends,
Harold, Reynolds, and Irving, helped me to do the experiments. Our operations
must have been a source of constant alarm to my parents and our neighbors. On
one occasion we decided to experiment with gunpowder. We mixed up several
pounds of saltpeter, charcoal, and sulphur, and some phosphorus according to the
formula, wrapped the mixture in newspapers, and put it on the sidewalk in back
of the house. Then we dropped a flat iron on it from the second-story window.
The iron almost took our roses off as we leaned out to watch the explosion, and
it did splinter the eaves of the roof. The noise was terrific beyond our
expectations and brought a policeman running to the scene. With the modesty
befitting scientists, we spent the rest of the day hiding in the cellar.
Whenever I return to Minneapolis I always make a point of seeing whether that
house, with the scars of the explosion, is still standing.

Sometimes the explosions were unpremeditated. I recall
concocting some mixture in a chocolate can and putting it on the stove to warm
up. I left it there too long, and the top of the can blew off with such force
that it stenciled the trademark in the ceiling. Then on another occasion my
friends and I had watched with great interest the building of a new house across
the street. The men from the gas company came one day to put in a connection to
the main. They did not finish the job that day and left their tools behind. We
opened the main and set fire to the escaping gas with a torch tied onto a fish
pole. The flame shot up like a volcano in eruption. It was a thrilling sight,
but we decided to leave it to the crowd which quickly gathered. Something told
us that our experimental zeal had been carried a little too far.

The most serious of my scientific pursuits was electrical
work. It started when Harold and I acquired a broken doorbell, complete with
button, bell, wires, and battery. We fooled around with this device until we
got it to work, and I learned the principle of the circuit in the process of
repairing it. I soon became as much interested in electricity as in chemistry,
and kept my friends busy stringing wires for me. When I was fifteen I could
wire a building as well as a professional electrician, and thought of earning
some money by my skill. But in Minneapolis there was a city regulation which
provided that a wiring job had to be inspected when completed, and only a
licensed electrician could ask for an inspector. I solved this difficulty by
going to see a man connected with the General Electric Company who was very much
interested in crippled children. He told me to go ahead and do the work, and he
would take care of having the request for an inspection come from a licensed
electrician. Under this arrangement I earned quite a bit of money. I also did
quite well in the summers equipping my uncle’s farm neighbors with the latest
thing in city doorbells. The confidence in myself that I derived from these
activities were far more important than the money I earned by them, for it
helped me to overcome my self-consciousness and to stop brooding over my
handicaps.

But I still feared the world for what it might think of my
handicaps. This fear had one good point: it kept me hard at work and I never
wasted much time in recreation. I stayed home when the others were out playing,
and my mother saw to it that I spent my spare time usefully. I got credit at
Bethel for the correspondence courses that I took during the summers, and so I
completed the high school course in two and a half years. My grades were good
enough to entitle me to a part in the graduation exercises, but I was still so
nervous about appearing in public that I could not even sit on the platform with
the rest of the graduation class, much less make a speech.

My parents had never even considered the possibility of my
going to college, but I had secretly dreamed of continuing my education and
becoming an engineer or an inventor. For a year after I graduated from Bethel,
college remained a dream which came to life in my mind whenever I passed the
buildings of the University of Minnesota or saw one of my schoolmates who had
been fortunate enough to go on to college. Meanwhile I continued my studies and
scientific experiments as well as I could at home and in the public library. My
heroes were Thomas Edison and Steinmetz, and I wrote them about my ambitions.
Their kindly replies strengthened by resolve to realize my dream. If Steinmetz,
a hunchback, could win recognition as an electrical wizard, I felt that there
might be hope for me despite my handicap. I drew up a plan for a gas engine
which was conceived on a new and original pattern. Since everyone likes to
encourage a cripple, my invention was highly praised by all who inspected the
drawing. As a confirmed reader of the popular science magazines, I knew how
important it was to get your invention patented before it was stolen by some
wily manufacturer, so I wrote to one of the patent lawyers listed in the
advertising columns. My engine never took more substantial form than a drawing,
but it involved considerable expense to my family. I paid a fee of $60 for a
United States patent, an then the lawyer suggested that my invention ought to be
protected in the other great countries of the world, and for this purpose went
most of my mother’s hard-saved $500 band deposit. Nourished as I was on tales
of millions acquired through simple inventions, I had no doubts about the
advisability of spending the money thus until it was gone. When a stream of
letters offering g to promote my invention-for a consideration-started to
arrive, there was nothing left, or otherwise we would have wasted more money.
Though this inventive interlude was a costly one, it did give me a sense of
personal worth. I could always point to my invention as an achievement in spite
of my handicap.

During this period of preoccupation with mechanical
devices, I had an experience which furnishes another example of the importance
of concentration to the spastic. A cousin of mine, who was then boarding with
us, owned an old Model-T Ford which he parked in back of the house. I had gone
on many drives with him, and thus learned how the car was operated. One day
when no one was around I used a hairpin to unlock the car and drove off down the
street. In my anxiety to control the car, all of the unsteadiness of my arms
and legs vanished. I drove safely around the block and was passing the house
again when Mother saw me, and my career as a driver was brought to an abrupt
close. No one could understand how I had managed to perform this feat. But the
explanation is that my attention was concentrated on guiding that car without
wrecking it myself and I was so absorbed in what I was doing that my muscles
obeyed my bidding. I now a man so severely handicapped by spasticity that he
cannon feed or dress himself who handles a car admirably in New York City
traffic and has driven across the country several times without the slightest
mishap.

I was desperately anxious to obtain some sort of
employment. At the Minnesota Sate Fair I met a Mr. Daggett, who was general
manager of a company which manufactured gas engines and electric motors. I told
him about my invention and my desire to go into research work. He took an
interesting me and sent me to the company’s plant in Beloit, where he thought
that I might find a job. This was my first trip alone, and it involved a good
many problems for me, for I was still dependent upon my mother for many personal
services I could not feed or dress myself without great difficulty, so my outfit
for the trip included a pullover sweater and shoes that could be slipped on
without buttons or laces. After our elaborate preparations for the expedition,
it was disheartening to find that there was no job for me at Beloit. Mr.
Daggett still felt that some job could be found for me, and he sent me to the
company’s works in Indianapolis; but the man I saw there discouraged me as far
as getting a factory position was concerned. He told me that I might have
better luck in the East, where there were research institutes in which my
physical handicaps would be disregarded if my brain was good enough. Eagerly I
wrote to several of these institutes, only to be cast down when I learned that
they employed only the most brilliant college graduates. After trying to obtain
employment in many other places, I finally came to the conclusion that I must
have more education-that a college degree, no matter how hard it might be to
achieve, would open the door which seemed to stand tightly closed between me and
a job.

A year after I graduated from Bethel Academy I learned of a
chemistry course which was being given at the summer school of the University of
Minnesota. It was just the sort of thing I wanted, but the tuition seemed
beyond our means until one of my mother’s friends offered to pay it. Only a few
students were taking the course, and I got along all right, since I never had
any trouble performing experiments when I was not conscious of being observed.
I lost some of my self-consciousness when I discovered that after the first few
days my fellow students paid no attention to the twitching head of our
professor, who suffered from a wry neck. It was curious how well I could manage
retorts and beakers when my mind was absorbed in a chemical problem, though I
was unable to feed myself when a stranger was watching me. I completed the
course with a good grade, and my success in this convinced my parents that I
could do college work, and in the fall I registered to a full course in chemical
engineering.

My interest in science, which was first aroused by reading
some books which belonged to my father and Gustaf Erickson, helped to carry me
through a period of life which usually presents tremendous difficulties for the
handicapped person. It is during the years of adolescence that a boy develops a
desire to manage things and to acquire the ability to support a wife, while a
girl begins to think about marriage. The handicapped are likely to despair of
attaining their ambitions and thus a psychological difficulty is added to their
physical liability. And frequently their ambitions are impossible of
realization. Fortunately I was able through the help of my friends to translate
into action some of the ideas which streamed through my head. There must be a
balance between physical and mental activity at this age if a breakdown is to be
avoided.

I did not get off to a good start in my college work that
fall of 1916. Ambition had led me to undertake a program of studies beyond my
powers. It did not take me long to discover that college chemistry courses were
a good deal more difficult than those I had taken in high school. I found it
impossible to perform the complicated experiments and to make the drawings which
were called for, in the midst of a large crowd of strangers in a packed
laboratory. I worked so slowly that I was always falling behind in my work and
having to take a bag of chemicals home to the makeshift laboratory that I had
set up for myself. The bustle and crowds at the university brought on again my
fear of people, and I did my best to avoid them. One day I was picked up as a
suspected saboteur as I walked along the railroad tracks with my bag of
chemicals, and I had some difficulty in convincing my captors that I was not in
the pay of Germany, that it was only a fear of crowds which had made me take
that path homewards. The physical confusion which my embarrassment produced
made my explanations all the more difficult and implausible.

At the midyear examinations I got low arks in all my
courses, and the dean advised my parents that it was useless for me to continue
in college. It was only then that I realized that it would have been far more
sensible to have taken the regular academic course than to attempt studies which
demanded skills which my handicap denied me. I was still interested in
chemistry, however, and felt that I might do better in a smaller college. A
schoolmate of mine at Bethel suggested that Macalester College in St. Paul might
be the right place for me. When I learned that the classes there were small and
that I would be allowed to go my own gait, I decided that my friend was right
and went there for the next year and a half. As when I shifted from public high
school to Bethel, the more favorable environment was reflected in good grades.

As I look back now on that unsuccessful start in college, I
feel that one of the causes of my failure was the helpfulness of the fellow who
sat next to me in all my courses. He took very full notes in shorthand and
later wrote them out on the typewriter. Since I could not take adequate notes
because of my difficulty in writing, I borrowed his in order to type out a copy
for myself. We continued this arrangement for several months, and then he had
the bright idea of making a carbon copy, thus sparing me the trouble of writing
the notes for my self. When the examinations came along, however, I could only
remember the facts to which I had given motor representation by putting them on
paper; the other ideas had slipped out of my head as easily as they had entered
it when I read over my friend’s carbon copy. Achieving motor representation of
ideas is an important factor in the education of the handicapped. A young
spastic who had done poorly in all subjects before receiving special training in
writing was afterward able to attain the highest standing in his class.

My mother died in January, 1918, after and illness of only
three days. She was a victim of the terrible influenza epidemic which swept the
country at that time. Since my father was also ill at the time, I had to take
charge of the funeral arrangements, though her death was a tremendous shock to
me. Whenever I had faltered in the struggle against my handicaps, she had been
at hand to help and encourage me. Our friends expected that this loss would
make me go to pieces, and consoled me by saying that I would soon be with
Mother. But I knew that nothing could bring her back, and was able to
rationalize her death and keep control of myself even at the funeral. Yet only
a few years before, when my mother had left me with my uncle for a month, I had
been inconsolable. My behavior in this crisis was typical of the spastic
confronted with catastrophe. Such crises are often beneficial in bringing about
a growth in personality, and an increased burden of responsibility often hastens
this development.

After my mother’s death our home was broken up. My father
went to live in a hotel near his job, and I lived with the family of my old
friend, Harold, who was then in the Army. After Harold got back from abroad, my
father and I shared a furnished room, but I saw little of him since he worked
nights and I was busy at college al day. My mother’s death made my lot harder
until I got used to being on my own. I had depended on her far more than I ever
realized until she was gone, both as a spiritual prop and for physical
assistance in such matters as dressing and feeding myself. But losing her made
me resolve to fight my own battles. Whenever I heard of a handicapped person
who made something of his life, I wrote to him for advice. One of the people I
communicated with was a Mr. Dowling, editor, banker, and speaker of the
Minnesota House of Representatives. At the age of fourteen Mr. Dowling was lost
in a blizzard and froze his legs and arms, which had to be amputated. He now
devoted himself to encouraging men who had been crippled in the war. On one
occasion someone in his audience of the ex-Service men, who was unaware of Mr.
Dowling’s artificial legs and arms, had said it was all very well for a man who
had all his limbs to talk about losing faith in life. Mr. Dowling promptly took
off his coat and trousers to supply physical proof that he understood the
problems of the crippled.

In answering my request for advice about employment, Mr.
Dowling suggested that it might be a good idea for me to see a newspaper
publisher, since I seemed to have some talent t for writing. My natural brass
carried me past the secretarial barriers into the office of Herschel V. Jones,
of the Minneapolis Journal, and enabled me to tell him my story. He was
good enough to take an interest in me, and gave me some good advice. He also
supplied me with an introduction to Dean Nicholson of the University of
Minnesota, who he thought might be able to find a job for me. Dean Nicholson
passed me on to Professor James T. Gerould, who was the University Librarian.
The library had just acquired some early English manuscripts, and Professor
Gerould offered me a trial at the job of cataloguing them during ht summer. He
warned me that this employment would be only temporary, but this did not bother
me in the least in my joy over finding work.

This cataloguing seemed made to order for me, since
accuracy rather than speed was the important consideration. I was not a fast
typist, and it seemed to me that I had little to show at the end of my first
day’s work, even though I had been given a room to myself, which saved me from
the confusion that always attended my first appearance among strangers in new
surroundings. So I took the manuscripts home in my brief case and sat up half
the night working over the catalogue cards. The following day I was able to
present a very respectable sample of my work to Professor Gerould, and he was
very pleased at my ability to do so much in so short a time. The job was mine,
and I shall never forget the thrill that my first week’s pay gave me. I felt
that I could rub shoulders with the world now, since I could earn my own way.
My father was proud of me too, though all he said was, “I can die now that you
can take care of yourself and make a living.”

When the task of cataloguing was completed in a few weeks,
Professor Gerould told me that the geology librarianship was vacant and that the
saw no reason why I should not have it. A conference with Professor Emmons, the
head of the geology department, resulted in my getting the job, which covered my
tuition and board. Therefore I transferred from Macalester to the University
that fall. I retained this post as librarian during the next four years while I
took my bachelor’s and master’s degrees at Minnesota.

Though my academic career prospered and I was set free from
financial worries, I became very much concerned about my father. My mother’s
death had depressed him, and it seemed to me that he spent most of his spare
time drinking. At that time I had a pious hatred of alcohol, and no doubt I
thought my father’s drinking was far more serious than it actually was. In it
he doubtless found the outlet for his grief which another man might have found
in religion. After the first anniversary of Mother’s death, he brooded more
bitterly over his loss, and I was worried about him. When I discovered one day
in February, 1919, that his revolver was missing from its usual place in the
bureau drawer, I was very much upset. As I waited for Father to come home, my
uneasiness about him became more and more acute. Finally there came a knock at
the door, and one of the neighbors told me that my father had had an
“accident.” As soon as she saw that I was half-prepared for the news, she told
me that he had shot himself through the heart. He did not die until the next
day was conscious until the end. Somehow, as in the case of my mother’s death,
I kept control of myself, though the crisis was even more acute this time
because I was left alone in the world.

Since there was now nothing in my life outside of my
studies, I buried myself in work. I made myself into a competent librarian, and
I did well in my geology major, despite my inability to go on field trips, by
doing far more reading than most undergraduates. Through the force of
circumstances I achieved in some measure the concentration which makes all
things possible to those handicapped as I was. People with whom I came into
contact at the University went out of their way to be helpful when the y learned
that I had been left an orphan. Professor Emmons, who was a prolific writer of
monographs on geological subjects, gave me enough extra work to keep me in
funds. Mr. Oscar Sullivan, the State Director of Rehabilitation, made it
possible for me to buy the books and instruments I needed in my college work.

It was through the friendliness of a doctor that I had my
first chance to take part in the social life of the University, which I had
previously decided was not for me. The University Student Health Services had
its quarters in the basement of Pillsbury Hall, where the geology library was
housed. One Saturday afternoon when most of the students and faculty were
watching the football game with Wisconsin, Dr. George McGeary, who was on the
staff of this service, found me hard at work and fell into conversation with
me. When he asked me why I was not at the game, I replied that I was afraid of
disturbing other spectators by the involuntary movements of my arms and legs,
and explained how I controlled them by holding one hand between my crossed legs
and the other on my chin. He told me that I was working too hard and getting
too introspective, and that I ought to get more recreation. As a starter, he
suggested that I come over to his rooms that evening to play cards. I told him
that I appreciated his kindness, but it was impossible for me to hold cards in
my hand.

Dr. McGeary would not take not for an answer and dismissed
my objections. So there was noting for it but to go to his bridge party, even
though I dreaded the fuss I might make in the embarrassment of meeting a group
of strangers. I underestimated Dr. McGeary’s understanding of my problem,
though, for he introduced me to his other guests as a “funny sort of fellow who
walks as if he were doing the Charleston,” and told them not to feel sorry for
me if I knocked things over. This may sound brutal, but it put me at my ease.
I never minded my unpredictable performances if those who witnessed them know
what to expect, and would laugh instead of pitying me. So IN enjoyed the
companionship of this evening, though I declined the refreshments, for fear of
sending a plate flying across the room.

Though the nervous tension which was partly responsible for
such incidents diminished as I grew up, I had by no means achieved complete
physical control. Once I stopped at a soda fountain for a milk shake and the
boy behind the counter was so busy that he threw my change to me instead of
putting it down. I was holding the milk shake stiffly in one hand, which flew
up when I tried to catch the coins with the other and sent the glass crashing to
the floor. Everybody in the store stared at me, wondering what was wrong with
me, and so intense was my embarrassment that I could never bring myself to enter
the place again. There were many such incidents in which I tried to move one
muscle and found my whole body involved in unexpected movements. I particularly
dreaded the coming of winter, for icy streets meant constant tumbles for me. I
dreamed of arranging my life when I grew up so that I could spend the winter in
the South and thus avoid such difficulties. A sudden gust of wind was enough to
send me sprawling when the pavements were slippery. There was a policeman on
duty near the University who picked me up once after the wind had blown me clear
across the street. We often traveled on the same streetcar and he used to
bellow at me: “Remember when you were so badly off that I had to pick you up out
of the gutter?” To the other passengers, this remark implied that I was a
hardened drunkard, and they used to shrink away from me. But I never minded
having fun poked at me in a joking way; it was openly expressed pity that upset
me and made things harder for me.

Often I had to leave theaters or concerts because one leg
would start jerking, and the more I tried to control it, the worse it goes.
This difficulty of mine was like the stage fright which often paralyzes a normal
person when he first appears on a platform; the harder he strives to overcome
it, the harder it is for him to deliver his speech. Gradually I worked out a
solution: instead of thinking about controlling my muscles, I thought of some
act that I had successfully performed in the past. But it was always hard for
me to do something in public until I had established the habit of doing it with
other people watching. Physical control came slowly through establishing
control of my emotions, and gradually the fright that crippled me wore off as I
became used to mingling with people whose arms and legs, unlike mine, had always
done as they were told.

Despite the pleaser I obtained in associating with other
people, I was always reluctant to go out socially at Minnesota. This reluctance
became greater after I overheard a conversation between a friend who had taken
me to a party and our hostess, in which he was taken to task for bringing a
person like me to a social gathering. On first acquaintance people always
thought I was a hopeless case, an unfortunate to be sympathized with but not a
person you wanted to have around. Later, when they learned that I possessed
normal intelligence and had used my head to compensate for my physical
handicaps, their attitude toward me usually changed. My unwilling hostess of
that evening has since become a very good friend of mine. The difficulty was
and is that most people do not realize how closely akin the problem of the
spastic is to that of the stutterer. The spastic stutters with his muscles,
and, like the true stutterer, gets along much better if he can let the other
fellow know his handicap and get him to laugh at it instead of being overly
sympathetic.

Though Dr. McGeary drove me into having some sort of a
social life, I did not slacken my scholastic efforts. Geology was my major and
anthropology my minor, and the courses that I took in these subjects under
Professors William Harvey Emmons and Ernest Jenks were the high spots of my
college career. I was also very much interested in Professor Andrew Stomber’s
Swedish literature course. Swedish, which I learned at home, was the only
foreign language that came easily to me, and I had never been able to get very
far with French and German. This lack of knowledge was a drawback in my work as
a librarian, and would have been a sever obstacle to my obtaining my master’s
degree if I had not chosen the geology of the Scandinavian peninsula as my
thesis subject. Such scholastic capability as I had was in science, and I had a
terrible time with subjects outside this field. My interest in anthropology led
me to take a course in anatomy, which gave me some idea of the processes
involved in my affliction. These facts were easy to acquire, since they had a
personal bearing; but it was a different matter in English courses where
activities in which I had never been able to partake were assigned as them
subjects. My concentration on science courses helped to improve my muscular
control, for laboratory work is excellent training in muscular co-ordination.
My ability to do the college work satisfactorily and to earn my way brought
about a great physical improvement; I acquired a sense of personal worth and
lost the sense of shame about my physical handicaps which had made me afraid of
being stared at and pointed at.

After I had taken my master’s degree in 1923, since I had
nothing to do during the summer, I asked Professor Emmons if I could clean up
the geology museum and rearrange the specimens. It was a job that badly needed
doing, and he told me to go ahead and have a try at it. I scrubbed the cases in
which the specimens were displayed and mounted each piece of mineral on a block
and relabeled it. At the end of a week Professor Emmons came in to see what
progress had been made. He was pleased with what he found and arranged to have
a couple of scrubwomen help me. When I finished up the job, he asked me if I
would like to do museum work regularly in addition to my librarian duties. Of
course I replied that I should be only too glad to have such work, and without
saying anything more to me, he got the legislature to make an appropriation for
the post that he wanted me to fill.

When he revealed what he had done, I was placed in an
embarrassing position, for Professor Gerould, who had gone to Princeton, had
offered me a job in the geology library there, at a better salary than my
Minnesota post. But I was still none too anxious to confront new situations.
My mental picture of Princeton was a college run on snobbish lines for the sons
of the rich, and I was not at all sure that I could fit into that picture. At
Minnesota I was known and allowances were made for my difficulties. Then, too,
I knew that I could do the work at Minnesota, but was not so confident of
filling the Princeton position satisfactorily. For the life of me I could not
arrive at a decision.

In my dilemma I consulted Mr. Jones, whom I went to see
about a job which would tide me over the summer. He got me to tell him all the
factors in the situation, and then reflected for a while. Finally he asked me
if I could get along on $10 a week. When I replied that I could very easily, he
said: “Well, I have no job for you, but I’ll give you that if you will do
nothing except get into the best possible shat to go to Princeton in the fall
and to do a good job when you get there. If the job doesn’t turn out well, you
needn’t feel that you’ve burned your bridges behind you by refusing the
Minnesota offer. You can fall back on me; I want you to feel that I’m taking
the place of your father. But understand this: I shall expect you to pay me
back when you can.”

Later on I learned the remarkable story of Mr. Jones’s
life. He had started as a typesetter and made his own way to the proprietorship
of a newspaper for which he refused an offer of $5,000,000. In his early years
he had borrowed $100, put it into the bank, and returned it six months later
with the interest which had accumulated. He did the same with a $500 loan, and
over a period of years built up his credit standing and the bankers’ confidence
in him to such an extent that he was able to borrow a large amount of money when
he wanted to launch his own paper. It was typical of him that he never
acknowledged my checks as I gradually repaid his loans to me, but when the
indebtedness was completely paid off, he told me to come to him whenever I had
need of “some healthy lucre.”

Thanks to Mr. Jones’s help, I spent a restful summer
building up my health. As the time for going East to Princeton drew nearer, I
became apprehensive. It meant a complete break with all my associations so far
in life, and the building of a new world on my own. When I considered how
slowly I made friends, the best that I could expect was a period of desperate
loneliness. And I felt less and less confident about my ability to perform the
tasks required by my new position. When I set off for Princeton in August 1923,
I did not enjoy the train trip East, for which Mr. Jones had supplied me with
funds- because every mile took me farther from home a closer to the dreaded
unknown. But, as matters worked out, I did not have an opportunity to feel
lonely once I reached the end of the journey.

I had to change at Trenton, and I was having a terrible
time managing my possessions when a fellow traveler helped me out. He was also
bound for Princeton, where his home was, and I plied him with questions about
the place. When he learned that I had come East to take a job at the University
and did not even know where to spend the night, he urged me to come to his house
until I could find a place to stay. There was a party at his home when we
arrived there, and I was reluctant to go with him, but he insisted on my doing
so. It turned out that his family were friends of Professor Gerould and he had
heard him talk of me, so they promptly took me under their wing. I was told to
make myself at home with them until I got settled. My new friends soon
discovered that my resources were modest, and they very kindly arranged room and
board for me at the Princeton Theological Seminary at considerably less expense
than would have been necessary elsewhere. With their help I found that the
worst of the difficulties that I had anticipated melted away.

Princeton was nothing like my mental picture of it. I
thought it was the most beautiful place I had ever seen, and if the majority of
the students came from wealthier homes than my classmates at Minnesota, they did
not show it by being stiff with one who did not share their background.
Professor Gerould’s familiar presence soon banished my fear of being alone in a
strange place, and it did not take me long to get used to my duties of issuing
books, filing library cards, and cataloguing new books. The library where I
worked was in Guyot Hall, and was not confined to geological books, since the
biology department had its stacks in the same room. My desk stood between the
two sections of the library, and I soon fell into the habit of browsing in the
biology books, which treated of matters relatively unfamiliar to me. There was
a biology seminar room adjacent to the stacks, and I got into the habit of
listening to the discussions that went on there while I was on duty at the
desk. In this way my interest in the subject was aroused, and I decided to take
some courses in it. After my first few days at Princeton it seemed ridiculous
that I had dreaded making the change so much, and I soon felt perfectly at home
in my new world.

During my first few weeks at Princeton, I met Professor
Charles Freeman Williams McClure, who taught anatomy and was a very well-known
embryologist. One day he came into Guyot Hall with a new book by Dr. Frederick
Tilney, the Columbia neurologist, which he wanted to donate to the library. It
was called The Form and Function of the Central Nervous System. He
suggested that I might be interested in reading it, since it would throw some
light on my handicap, and that its author might be able to help me overcome my
difficulties. As a matter of fact, Professor McClure wrote to Dr. Tilney, who
happened to be a close friend, and arranged an appointment for me without saying
anything more about it until the matter was settled. Naturally I wasn't only
too eager to take this opportunity to consult on of this country’s most eminent
neurologist, and I went off to New York confident that I would acquire a better
understanding of my problem.

After explaining my neurological symptoms to me, Dr. Tilney
offered me some real encouragement by saying that I had done wonders in
overcoming my handicaps to such a degree by myself. He made me understand how
fortunate I was to be able to earn my living, since the very struggle for a
livelihood, hard as it might seem, would have a good influence on my progress.
He made me feel that he was very much interested in my career and urged me to
come and see him at least once a year. Though I deeply appreciated his kindness
and meant to keep in touch with him, I did not return to his office for some
years. Nevertheless, it was a real shock to me when Professor McClure told me
one day in the library that Dr. Tilney had suffered a severe stroke and would be
crippled if he recovered. Late I heard the story of his indomitable struggle to
regain his health, and how he produced numerous scientific papers while he was
still confined to a hospital bed.

It was not long before I started enjoying life a good deal
more than I had at Minnesota. I made many acquaintances in my work at the
library, and I soon had plenty of companionship. My particular friend at this
time was a young theological student, with whom I had some amusing times. One
day he asked me to go canoeing with him on Lake Carnegie. I go the loan of a
canoe from a faculty friend of mine, and we started off. But there was a slight
difficulty; neither of us knew how to paddle and we soon tipped over. Though
the water was only a foot deep, I almost drowned in my excitement over the
accident. Another time he cam to my room one warm evening with two open
ginger-ale bottles and asked me if I wanted to have a drink with him. I agreed,
and very shortly became aware of a rapidly mounting sense of well being. I
announced that I had never felt like this before, but the only reply he made was
a chuckle. When I poured out the first glassful, I had needed two hands to hold
the bottle; now I could fill the glass with one hand and raise it to my mouth
without spilling a drop. This was so unusual that it seemed a miracle, and I
was marveling about it when my friend took pity on my innocence and informed me
that the ginger-ale was strongly laced with gin. It was the first alcoholic
drink of my life. Much to my surprise, I found that alcohol, of which I had
always had a pious hatred, had a curiously stabilizing effect on me. My friend
told me that I seemed more sober after several drinks that I normally did. But
I discovered that the improvement in my muscular control was only temporary,
that the original difficulties were increased for a short period after the
effect of the alcohol had worn off. These facts, coupled with my feeling that
drinking had played a part in my father’s suicide, were enough to deter me from
habitual use of alcohol. But I began to wonder if there was not some other way
of achieving the same loss of self-consciousness which brought about such a
miraculous improvement in physical control, and eventually I found it.

To my inability to walk properly at this time I owe another
friendship which completely altered the course of my life. One winter day in my
first year at Princeton I slipped on some ice-covered steps and took a bad
fall. A fellow named Stillman, with whom I had had a few conversations when he
was taking books out of the library, happened to be there at the time. He
picked me up and saw that I was taken to the college infirmary. Not content
with that good turn, he came to see me while I was recuperating from the effects
of the fall, and we soon became friends. We were in the same course in biology,
which I was taking mainly as an aid to my library work; and he arranged matters
so that he was my laboratory partner and could help me when I found myself at a
disadvantage because of my lack of manual dexterity.

This Bud Stillman was a tall, red-haired chap, who put on
no airs at all and seemed very shy. From all appearances he had no more money
to spend than I did, so that it was some months before I connected his name with
that of the wealthy Stillman family, whose marital difficulties had filled the
newspapers in 1921. At that time I held some of my father’s socialistic views
and his contempt for the much-publicized doings of the rich, and I had paid
little attention to these stories. If anyone had told me then that the Stillman
family would one day play an extremely important part in my life, I should have
thought him mad. It certainly was improbable that the paths of a Minneapolis
laborer’s son and of a New York’s banker’s son should cross, and that two people
of such different backgrounds should become friends. It was something that
could happen only in America, where friendship is not dependent upon birth or
wealth.

Though I began to see more and more of Bud after fate had
thrown us together, I had other friends during this first year at Princeton.
One of the best of them was Dr. Stewart Paton, a psychiatrist, with whom I came
in contact when he conducted a biology seminar. He was a friend of Dr. Tilney
and developed an interest in me after I had told him how much insight into my
difficulties I had gained from a visit to the New York neurologist. By giving
me a copy of his book on human behavior and discussing the questions that arose
in my mind as I read it, Dr. Paton furthered the growth of this insight. In
turn I made a note for him of anything that had a bearing on his special
interest among the new periodicals and books that came to the library.
Sometimes we continued in his home discussions that had begun in the library.

During the summer I had a month’s vacation form my library
job, which I spent working at the marine biology laboratory on Mt. Desert Island
in Maine. It was wonderfully cool there after the hot Princeton summer, and I
enjoyed my stay very much. A number of eminent scientists took a busman’s
holiday at the laboratory; and I acquired a good deal of knowledge while having
a very pleasant time. The general atmosphere was un-academic, though a lot of
serious work was accomplished during the course of the summer.

My stay at Mt. Desert was my first taste of New England
life, which appealed very much to me. Since my blood is Swedish on both sides
of the family, I am at a loss to account for the lasting fondness I acquired at
this time for the Puritan ritual of baked beans and brown bread on Saturday
night.

When I returned to Princeton for my second year, I took on
an instructorship in bibliography in addition to my duties as librarian. This
gave me a substantial increase in my salary, so that I did not have to worry
about making both ends meet, and I could reduce my debt to Mr. Jones. I moved
from the theological school to the Nassau Inn, and then to a room in Brown Hall,
one of the campus dormitories. These changes in living quarters brought me more
into the life of the college, and I began to see more of Bud Stillman and to
become less of an academic recluse. One week end Bud suggested that we go up to
New York and see a show or two, as a break in the routine. I agreed, saying
that I had to go to Baltimore the following Monday for an operation on my foot,
which might help me to walk more easily. We spent the night in an inexpensive
hotel in the Times Square district. Bud left me on Sunday, saying that he
wanted to see his father before going back to Princeton, while I stayed on at
the hotel until it was time to go to Baltimore.

The trouble with my foot was a spastic condition which
stiffened my toes a right angle to the foot. Whenever this occurred it was
extremely difficult for me to walk or event to put my boot on. One remedy that
had been suggested was a tendon operation that would affect all the toes. But
Dr. George Bennett of Johns Hopkins, whom I consulted in Baltimore, discovered
that the increased spasticity was caused by the rubbing of the little toe
against the shoe, and by amputating this toe he eliminated the difficulty. This
minor operation brought about a great improvement in my general condition. I
gained twenty pounds and was soon able to take ten-mile walks. While I was in
the hospital, Dr. Bennett brought Dr. Walter Dandy, the famous brain surgeon, to
see me. Dr. Dandy got me to tell him my story and took X-rays of my head in
order to find out what portions of the brain had been affected by my birth
injuries, and what hope there was for further improvement. He cam to the same
conclusion as the other doctors who had examined me: that mine was a case that
neither medicine nor surgery could help. He advised me, however, to continue
trying to win control over the muscles that would not obey orders, and made me
promise to let him know from time to time how I was getting on.

I returned to Princeton before my foot had completely
healed, so I lived for several weeks in McCosh Infirmary, which was across the
street from Guyot Hall, in order to avoid using it too much. They treated me so
well at the infirmary that I soon felt more at home than if I had been in my own
quarters. Bud Stillman was laid up there with a cold, and we shared a room, so
I did not lack companionship. It rather surprised me that he asked no questions
about my operation, but I forgot all about the matter until we went up to New
York again together and spent the night in the same hotel. As we registered,
the desk clerk gave me a letter which by some mischance ha not been delivered to
me before I left for Baltimore. It contained a large check from Bud, and a note
asking me to use it to see myself through the operation in style with a private
room and a special nurse. Only then did I realize that he must be a member of
the wealthy family I had read about in the newspapers.

Before we went back to Princeton, Bud took me up to his
father’s Park Avenue house and introduced me to him. I must have given a very
poor impression myself to Mr. Stillman, because the novelty of my surroundings
gave me an appalling case of stage fright. The house seemed to me a combination
of a palace and a museum, and I was tormented with the fear that one of my
unanticipated motions might destroy some valuable ornament. We had tea, and my
unruly muscles sent a teacup crashing to the floor just as I was trying my
hardest to appear at ease. Bud, I knew, would not mind, for he had become used
to my impromptu performances of this sort; but I did not dare to speculate as to
what Mr. Stillman thought of me. But seemingly he did not notice what had
happened, and went on talking to me in the pleasantest sort of way. In fact, he
asked me to come and stay at the house whenever I was in the city.
Nevertheless, it was a great relief when we had to leave for our train, and I
could relax once more. I had never lost my childish dread of new faces and
situations, and this glimpse into a world utterly unfamiliar to me made it worse
than ever. As I left the Stillman house that day, I never dreamed that it would
become a second home to me within the next few years.

My work at Princeton went well enough, but gradually I
became aware of the fact that I was in a blind alley. The instructors and
students whom I encountered at the library were engaged in research work which
led to the writing of books and papers for the scientific journals and to
promotion in the academic world, while I just went on performing the duties of a
routine job which led nowhere. I recalled my earlier ambitions and decided that
I did not want to be a librarian all my life. I was no longer content just to
earn my own way; I wanted to make my life a more useful one. Bud and I often
had long discussions in which we settled the fate of the world to our momentary
satisfaction, and in one of these sessions he suggested medicine as a career for
me. He himself was planning to go to medical school when he finished college,
and he made a good advocate for the profession he had chosen. He pointed out
that I had taken most of the required premedical courses simply because of my
interest in them, and suggested that it might me sensible to make a vocation out
of what had previously been only an avocation. As a matter of fact, I had
already considered the idea, because one of my Chicago cousins was going into
medicine, and I had a jealous desire to imitate him. But I had dismissed the
idea as both physically and financially impossible for me.

Now it occurred to me that I might be able to help others
who suffered from the same handicap as I did by acquiring at least the
fundamentals of a medical education, even if I could not become a doctor. I
thought enough of the idea to go down to Baltimore and talk it over with Dr.
Dandy. He told me that the success I had in overcoming my own handicaps should
be invaluable in helping others, and that a medical degree would be essential if
I wanted to do any serious work of the sort I had in mind. Though he foresaw
that it might be difficult to win admission to medical school, he expressed
confidence in my ability to overcome this obstacle, and topped off his
encouragement by offering to finance a year of my professional education.

Once I had decided upon medicine as the career I wanted to
follow, I took courses in biochemistry and physiology and read everything in the
library that looked as if it might be helpful in attaining my new goal. Before
I left Princeton that summer for another working holiday at the Mt. Desert
laboratory, I wrote to Mr. Jones in Minneapolis about my plans, and asked if he
would be willing to help me again financially, provided I could win admission to
a medical school. I wanted to be sure of at least two years’ freedom from money
worries before I abandoned a field in which I was successful in order to prepare
for another in which my prospects were doubtful, to say the least. Through an
accident I did not get Mr. Jones’s affirmative reply until I returned to
Princeton and I had a bad time of it until I heard from him. Then I started my
campaign to get into a medical school.

It proved to be a long-drawn-out campaign. I was turned
down by the deans of several medical schools on the grounds that I was too
severely handicapped to be able to practice medicine, even if I could get
through the four-year course, which most of them seemed to doubt. One dean with
whom I had an interview happened to have a spastic child, and told me quite
frankly that he was not spending any money on the child’s education, because
“there was nothing to do but try and keep the poor kid happy.” This dean said
that he admired my ambition, but could not help me to waste four years and a
good deal of money in attempting the impossible. All this was rather
discouraging, and if it had not been for Dr. Dandy’s encouragement when the
prospects seemed darkest, I doubt if I would have kept up the fight. In the end
I won admission to the Yale Medical School as a special student, on the basis
that my showing in the first two years was to determine whether I should be
allowed to continue studying for a degree.

Dr. Dandy had suggested that I apply at Yale because of a
new system which the medical school there had adopted. During the first two
years of the course there were optional quizzes, but no examinations for credit,
until the student felt ready to take a comprehensive test on everything that he
had studied. In this way a student could accomplish his work at his own pace,
without having to devote all his attention at regular intervals to examinations
in particular subjects. The system was much more like that which is traditional
in the English universities than any other American educational plan of the
time. Examinations always put me into a state of extreme nervous tension, and
under any other system than this one, I probably could not have gone through
medical school.

The lack of confidence displayed by a number of competent
authorities in my ability to realize my ambition made me less optimistic than
when I first decided on medicine as a career. I managed to obtain a two-year
leave of absence from my Princeton job, so that I would have something to fall
back on if the medical school work proved too much for me. It was not difficult
to obtain this leave, since the courses that I was going to take would give me a
better equipment as a librarian. The feeling that I had not burned my bridges
behind me made the prospect of another transition much easier on me than when I
had to decide between staying on at the University of Minnesota or going to
Princeton. But before embarking on my new career, I was glad to renew old
friendships by going to Minneapolis to spend my last vacation from Princeton.

I entered the Yale Medical School in September, 1926.
Thanks to the kindness of Dr. Dandy and Mr. Jones, I was free from financial
worries for the time being; and my three years at Princeton had increased my
self-confidence. My old dread of meeting new faces and situations was allayed
when I found my Princeton friend, Dr. Stewart Paton, had come to Yale as head of
the psychiatric department. Seeing his familiar face made me feel at home. He
took a great interest in getting me off to a good start and gave me a
Dictaphone, which proved most useful in my written work. Various members of the
medical faculty went out of their way to be helpful-not so much because I was
handicapped, but because I wanted to aid others who had difficulties similar to
mine. I plunged into the medical school work with the resolve that I would make
a good enough showing to eliminate all doubts about my ability. But I soon
discovered that medical school was a different matter from college, and that the
work was much more extensive and demanding. After a day of classes I was so
exhausted that often I went to bed directly after dinner, and then got up a few
hours later and studied until three or four in the morning in preparation for
the next day. I found it difficult to study in the boarding house where I had
taken a room. When I mentioned this to Dr. Harold Burr, the professor of
neurology, he gave me an office in the laboratory. Here I kept my typewriter
and books and could work at any time of the day or night. This arrangement was
a great help, because it was still hard for me to get much done in the midst of
a crowd.

That first year I had courses in anatomy, biochemistry,
physiology, and bacteriology. Anatomy is traditionally the error of medical
students, and I was no exception to the rule. Only its connections with other
matters in which I was more interested made its dryness endurable. I had a good
deal of trouble with the dissecting which is such an important part of the study
of anatomy, and had to get help from the other student who was working on the
same cadaver. As long as I was completely absorbed in my work, everything went
well enough, but if I started to worry about controlling my hands, I was likely
to jerk the piece of tissue to pieces. My dissecting partner’s assistance had
its advantages, for though I remembered with out difficulty the grosser muscle
groups which I could dissect myself, I had a hard time recalling the structure
of more delicate systems, in dissecting which I had received help. As in the
case of the borrowed lecture notes at Minnesota, those ideas which received
motor representation were more firmly fixed in my mind. At the Columbia College
of Physicians and Surgeons the students are obliged to reconstruct muscle groups
and other portions of the body in plasticine, as well as to dissect a cadaver.
Thus the anatomy of the human being is doubly fixed in the memory by the
processes of taking it apart and putting it together again.

This hand-in-hand relationship of physical and mental
activities has an important bearing on the proper treatment of the spastic.
Many parents feel that their handicapped child can be cured simply by a course
of exercises designed to develop the affected muscles, and put off schooling
until this cure can be brought about. This is a tragic error, for exercises are
useless without simultaneous mental training. I was fortunate in not having as
a child systematic physical training based upon the principal of motion for
motion’s sake, but rather in being forced by circumstances to move my muscles
purposefully.

Almost everything I studied gave me some further insight
into my difficulties. I learned that every human being passes through stages of
development which parallel those of the lower orders of life: first squirming
like the simplest forms of marine life, then wriggling like a snake, then going
on all fours like a dog, and finally learning to walk unsupported on its legs.
During this evolution, there is a simultaneous development of the brain and
nervous system. The mind learns to associate a certain sensation with a certain
muscular movement, and gradually the muscular response to the sensation becomes
automatic. The ability to recall the sensation determines the ability to
perform the movement. I had to struggle against wrong motion patters; various
irrelevant and involuntary movements had become associated with each conscious
movement. My difficulty was like that of the beginner at the piano, who finds
it impossible to move one finger without also moving several others. The remedy
is the same in both cases; only through exercises which develop the ability to
perform precise movements at will can the desired control be obtained. Even so,
the correct motion patterns may be obliterated by fear or anxiety. A normal man
finds no difficulty in walking along a narrow plank which lies on the ground.
If the plank is raised twenty feet in the air, he will go through the same
motions painfully and hesitantly, granted that he can perform them at all. He
is experiencing the difficulties which beset the spastic at all times. “To be
scared stiff” is no empty figure of speech, but a singularly exact one when
applied to the spastic. Fear destroys the concentration which enables him to
control his unruly muscles.

A good many of the facts I had to learn in medical school
seemed at first to have no bearing on my particular interest, and I felt that
studying them was a waste of time. One such matter was the biochemistry of
respiration, which I subsequently found far from irrelevant to the problem of
spasticity. Irregularities in breathing cause certain chemical changes in the
blood which result in increased muscular tension. The effort to make my arms
and legs obey orders always made me hold my breath, as the normal person does
momentarily in threading a needle. Only in my case I would stop breathing so
long that my mother thought I was going to choke, and then gulp in the air.
This marked irregularity in breathing, of course, increased the muscular
disorder by increasing the muscular tension. Training in correct breathing is
important to all spastics, and I have seen tremendous improvement brought about
in some cases by breathing exercises alone.

It is dangerous for the medical student to undertake his
professional training as I did, with his life work already determined, for he is
apt to neglect the acquisition of the broad background essential to alter
specialization. Too much concentration in medical school on a special interest
may make him unable to see the woods for the trees when he starts practice.

In addition to the regular medical school work, I had a
daily session of physical training under the direction of Dr. Winthrop Phelps,
the professor of orthopedic surgery. Noon was the only time I had free for
taking this training, and I shall always be grateful to Mrs. Caroline M. Brown,
the chief of the physical therapy department at New Haven Hospital, for giving
up her lunch hour in order to put me through my exercises. Both Dr. Phelps and
Mrs. Brown were somewhat skeptical about my deriving much benefit from physical
training at an age when I had so many well-established wrong motion habits to
overcome. They were amazed by the improvement I soon began to show, in which a
number of factors were undoubtedly involved. The exercises themselves played an
important part in it, and I was fortunate in having a trainer who knew how to
teach the concentration which kept the old motion habits in abeyance. My own
past experience in controlling these patterns, when it was essential to do so
for some absorbing practical purpose such as a chemical experiment, was also
helpful. But what seems to me one of the most important factors in the
situation was my state of mind. The exercises went well when other things were
going well, and poorly when I was upset about something.

During my training periods I discussed with Mrs. Brown this
connection between the physical and emotional aspects of my handicap. The
conventional orthopedic view was that improving the physical difficulties would
bring about a better psychological attitude, but I felt that the way to better
physical control lay in control of the emotions. Whenever I received
congratulations for showing physical improvement, I could always find an
explanation in some incident which had increased my self-esteem. At the time
when my physical progress was most marked, I was enjoying a greatly increased
sense of personal worth, thanks to having won the affection of a girl for the
first time in my life. The usual intensity of a first love affair was augmented
in my case by the fact that with the spastic love is a much more serious matter
than with the normal person. He who has though of himself as being cut off from
the rest of mankind by his handicap suddenly discovers that the barrier has
vanished and he idealizes the girl who has released him from isolation. This
avalanche-like emotional reaction makes love a serious problem for spastics,
because it is difficult for them to choose the right mate when they are apt to
be swept off their feet emotionally whenever anyone takes a personal interest in
them.

Mrs. Brown and her husband became friends of mine, and I
spent many pleasant week ends at their home in the country outside New Haven. I
felt more at home with them than I had at any time since leaving Minneapolis,
and these week ends put me into fine shape for the work of the next week. The
poise and self-assurance that I gained in this way were always reflected by
improvement in my muscular control and a better showing in my physical
training. Whenever I succeeded in losing the feeling that I was alone and
helpless in the world, the benefits obtained from my exercises would be carried
over into everyday life. Whenever I became dejected or depressed about the
future, this important carry-over was not achieved. I do not wish to belittle
the value of physical training for the spastic, but the importance of the
patient’s own emotional attitude and of the trainer’s ability to promote a
favorable attitude is too often neglected.

Bud Stillman was to be married in July at his mother’s camp
at Grand Anse in Canada, and he insisted on my coming to the wedding. So at the
end of my first year of medical school, I started off for Canada. I had to take
one train to Montreal, another to Trois Rivieres, and a boat for the last
seventy miles up the St. Maurice River. The “camp” proved to be a large modern
house which stood on a bluff overlooking a bend in the river and was the center
of a domain extending for hundreds of square miles. Forty or fifty servants
were needed to run the estate, which was on a scale so tremendous and luxurious
that it frightened me. In the bustle and confusion of the wedding day I had
little chance to do more than congratulate Bud and his bride, who left
immediately after the ceremony on their honeymoon, a year in Europe. On the
following day, when most of the guests were preparing to depart, Bud’s mother,
whom I had just met for the first time, urged me to stay on at the camp. She
was not a woman whose requests could easily be refused-and, besides, it did not
need much persuasion to make me fall in with her idea.

Mrs. Stillman had heard all about me from Bud, and she felt
that a summer of outdoor life would be the best possible preparation for my next
year’s work in medical school. Under her guidance I had the most active time of
my life. She never allowed me to avoid taking party in whatever was going on
because of my handicaps. She drove me to a morning dip in the icy water like a
hard-hearted drill sergeant; she made fun of my fears when I found myself in new
situations. She told me that I had to paddle my own canoe in life, and that I
might as well start by going out on the river alone. Remembering my near-escape
from droning while canoeing at Princeton, I kept close to shore and found
comfort in the fact that there were several Indian guides within call on the
bank. Gradually I lost my timidity and ventured farther from shore. Then I got
caught in a current which drew the canoe toward some dangerous rapids. Fear
seized me and seemed to make it impossible for me to use my arms. I looked
ashore for help, but there was not a soul in sight. I realized that I would
have to save myself. Somehow I managed to free myself from that paralyzing fear
and to paddle steadily back to shore. As the canoe touched the bank, the guides
stepped out from behind the trees where they had been hiding al the time at Mrs.
Stillman’s orders. She had wanted me to gain self-confidence by getting out of
the difficulty by myself, without knowing that help was at hand if I should not
succeed.

The next morning at breakfast I complained that I had not
had much sleep because of a nightmare. Mrs. Stillman, who had been
psychoanalyzed by Jung, was very much interested in the interpretation of dreams
and got me to recount mine. It had seemed to me that I was out in the middle of
the river in a canoe, and instead of having the muscular control which I had
built up in thirty years of my life, I had only as much as when I was ten. I
had upset the canoe in my flurry of unintended movements, and then I woke up and
found that I had fallen out of bed. Mrs. Stillman thought this dream most
interesting, and said it showed that I was the victim of infantile fears.
Whenever I got into difficulties thereafter and started to complain about my
inability to do something, she would tell me not to let the ten-year-old Earl
get control. I acquired some valuable bits of psychological insight from my
conversations with Mrs. Stillman She showed me how brooding and introspection
destroyed one’s character, and how important it was to translate one’s fantasies
into reality. Much of what she said fitted in with what I had learned during my
first year of medical school, and helped to increase my understanding of myself.

The outdoor activities which occupied most of our time at
the camp provided many opportunities to increase my muscular control. Though
learning to shoot was a somewhat painful process for me, the first time I fired
a heavy deer rifle the recoil knocked me sprawling to the ground-it have me
useful training in coordinating vision with a muscular act. I made a bull’s-eye
once by accident when I was still new to shooting, but could not even hit the
target for a long time thereafter because I tried too hard and became too
tense. Eventually I learned how to avoid expending to much effort, and I became
a better marksman. Later on in my life I learned of several cases in which
spastics made great physical improvement by engaging in regular target
practice. The long camping trips over rough country increased my ability to
handle myself satisfactorily in everyday life. Spurred on by Mrs. Stillman’s
constant reminders about banishing the ten-year-old Earl, I managed such feats
as crossing streams on fallen logs and struggling over rough portages. I ate
meals of heroic proportions because Mrs. Stillman told me that it would be
criminal to waste food which had been brought into the wilderness at
considerable expense, and also because my appetite had grown enormously.

The world of the Canadian woods was completely new to me,
but I quickly learned to enjoy it under Mrs. Stillman’s guidance. I got used to
seeing big game at home in the woods; to eating fresh-killed moose steak and
fried fish that had been swimming in lake to stream an hour before. As a grown
man I was doing all the things that Harold and I had played at back home in
Minneapolis as children, and sometimes I wished that he could share the delights
of these new occupations with me. It occurred to me that this sort of life gave
those who did not have to do physical labor the motor activity that the human
system demands if it is to remain healthy. My socialistic father, who was
convinced that rich people never lifted a finger if they could avoid it, would
have been amazed to see how cheerfully they sweated under heavy loads on a
camping trip. That summer did me a tremendous amount of good, and I returned to
New Haven in the fall in far better mental and physical shape than when I had
left in June.

During my second year of medical school I took a course in
pathology under the dean of the medical school, concerning whom there were many
legends. His manner was harsh and exacting, and he kept his students on their
toes. He demanded clear answers to his questions and could not be put off with
a comprehensive medical expression which covered a complex mass of facts. When
such an answer was given, he would say: “Now tell me what that means in simple
terms, such as you would use to describe an apple to an Eskimo.” Often when I
was called upon, embarrassment would make me forget what I knew. I would get
completely flustered and be unable to say what had been at the tip of my tongue
the moment before. My mental confusion would bring on an uncontrollable
shaking. Instead of being sympathetic, the dean would say: “Carlson, you’re
nervous because you don’t know. Don’t think we’re going to pass you just
because you’re a cripple. Go home and study harder!” And he was right about
it. In trying to keep up with the work, which is difficult enough for the
un-handicapped person, I was not studying thoroughly enough. Though the dean
gave me some very bad times, I am grateful to him for finally knocking out of my
head the tendency to take advantage of my handicap. I studied harder, and the
next time I was called upon I could recite without shaking.

But at the time, these rebukes were terribly discouraging,
and I told my adviser that I never expected to get through medical school while
a man who had such a poor opinion of me was dean. The adviser replied that the
dean was as much interested in my progress as anyone, abut that he was opposed
to babying students along. To illustrate his point that the dean’s bark was
worse than his bite, he told me how one applicant had won admission to Yale.
The would-be medical student was looking for the dean’s office, when he
encountered a short figure in a dirty laboratory coat, clearing up after an
experiment, whom he mistook for a janitor. Asked where that tough little
so-and-so could be found, the dean gave the young man directions, got dressed,
and went to this office. He then opened the interview by telling the applicant
in detail just why the medical profession had no place for someone so completely
lacking in the instincts of a gentleman. The young man finally managed to get
in a few words to the effect that he had already been accepted at the Harvard
and Johns Hopkins medical schools; and, since it looked as if there was no place
for him at Yale, he would go where he was more welcome. The dean liked this
reply, which showed that the young man had some reason for being cocky, and
promptly accepted him for Yale.

There was another incident which revealed the dean’s habit
of saying exactly what he thought: he once called upon a student named Brown,
and when an obviously Jewish person answered to that name, the dean quickly said
in Yiddish: “You’re no Brown. Why did you change your name?” If was just the
natural reaction of a man with a passion for exact definition.

The dean’s driving energy and executive ability made him a
remarkable administrator, as well as an excellent teacher. Under his guidance
the Yale Medical School expanded tremendously, and its resources in many special
fields were greatly increased. The growth was so rapid that I had difficulty in
recognizing the place from year to year. The dean always managed to raise funds
for any new project that seemed useful to him, and his success in this respect
was outstanding even in a period when the whole university was undergoing a
period of remarkable physical growth.

At the end of my second year at Yale I took the
comprehensive examination which covered all the pre-clinical work. In my
struggle to keep up with the heavy load of work, I had insufficient time to
review, and my nervousness over the examination made me forget what I knew
perfectly well. The examination involved both written and oral tests, and in
the latter my old difficulty with new faces and situations caused me to make a
miserable showing. The medical school authorities decided to take these factors
into consideration and allowed me to continue my studies in the pre-clinical
courses during the following year, and to take examinations in each subject as I
felt ready for them. Matters were arranged so that I took these tests in the
privacy of a professor’s office, and was allowed more than the usual time to
complete them in, since I wrote more slowly than the average person even when I
typed. But I was held strictly to the same standard of knowledge as the other
students.

At this time I had to decide whether to continue in medical
school or to return to library work at Princeton, for an attempt to get my leave
of absence extended for another year failed. In my perplexity I wrote Bud
Stillman that I thought of going back to Princeton, because of lack of financial
security to finish my medical course. He loaned me a sum large enough to cover
my expenses for another year, saying that he did not want me to give up the idea
of becoming a physician and that I was not to worry about money. This
generosity made it possible for me to resign the Princeton librarianship, and
once I had abandoned all thought of going back to the old way of life, I was
able to settle down and concentrate on preparing myself for my new career.
Knowing that I had nothing to fall back on if I failed in medical school acted
as a psychological spur, and I did much better in my work once this decision was
made.

Mrs. Stillman invited me to return to Grande Anse that
summer, and I was only too glad to do so. Bud and his wife also spent the
summer at camp, and we had some great times together. I shall never forget one
expedition Bud and I made that summer. We started off alone one moonlight night
in a canoe to reach one of the log cabins scattered at convenient intervals over
the Stillman property. I was in the bow, keeping a lookout for rocks and snags,
while Bud paddled. I warned him of a big rock which loomed up ahead; and, just
as he swerved the canoe to avoid it, the “rock” revealed itself as a bull moose
which went splashing off into the darkness. We came to a portage, over which
Bud gave me a hand, for all my old helplessness returned when I could not see
where I was going. He left me at the foot of a waterfall and went back for the
canoe and our packs. It seemed a long time before he reappeared, and I was glad
that the noise of the falling water drowned out the mysterious rustlings I had
heard in the woods as we came along the trail. A few days before I had seen a
bear and its cubs close to the spot where I now sat alone in the dark, and
somehow I was not anxious to renew my acquaintance with the family. That night
after we had gone to bed I thought I heard some animal moving about close to us,
and the next morning we found what we thought were the tracks of a wolf. This
theory was soon disproved by the appearance of a dog which had followed us
unseen the previous night. Such experiences as these, in which there was
sometimes real cause for fear, did not disturb me as much as some trifling
occurrence in everyday life, because I was too absorbed in what I was doing to
worry about what might happen. In my desire to keep up with the others and not
being the way, I acquired accomplishments far beyond the wildest expectations of
my earlier days

That fall bud entered the Harvard Medical School, and we
saw a good deal of one another again. Every few weeks we would get together in
Boston or New Haven, and occasionally we went to New York. His father set aside
a room for me in the Park Avenue house and made me feel like a member of the
family. Gradually I lost my dread of the surroundings which had been so strange
to me, except in one respect. In the center of the dining-room table there was
a boat made completely of glass, which I knew to be a very rare and valuable
piece, and I never felt comfortable when seated near it. I was positive that
some day an unexpected movement of mine would send that ornament crashing to the
floor in a thousand pieces; but fortunately this foreboding was never realized.
Mrs. Stillman was extremely kind to me, and when I spent my Christmas vacation
with him, he presented me with some fifty medical reference books, which were
most welcome. Whenever the grind at New Haven became too much for me, I went to
New York for a few days of luxurious coddling, during which I kept up with my
studies while resting in bed.

One of my visits to Bud in Boston had an amusing sequel.
We spend and evening building castles in the air about our plans after we were
both qualified physicians. We evolved a notion of a model clinic for those
handicapped as I was, and worked out all the details. Much to our surprise, we
found the whole scheme reported satirically in the next day’s newspapers. A
servant smarting under a recent reprimand had overheard our conversation and
taken revenge on his employer in this way.

Meanwhile I passed the examinations in the pre-clinical
subjects one by one and worked on my thesis, a bibliography of the basal
ganglia. This most primitive part of the forebrain has been the source of much
speculation since the beginning of anatomical study of the brain. Swedenborg,
who was a great anatomist as well as a religious leader, thought this part of
the brain the seat of primary sensibility of body and soul, and he added that
“all determinations of the will descend by that road.” Injuries to this brain
structure produce loss of motion as well as excessive movement. In the basal
ganglia explanations may also be found for rigidity, postural disturbances,
partial paralysis, tremor, tics, gait disturbances, personality changes, and
many other disorders. With so many functions attributed to one structure of the
brain, it was no wonder that I found more than ten thousand articles on the
subject. But it was surprising how little research had been devoted to methods
of therapy. There was abundant material on the anatomy, physiology, and
pathology of the basal ganglia; but the few suggestions about treatment did not
go much further than the common-sense methods which my mother had adopted in my
case out of necessity. As I sifted this enormous mass of material, I recalled
the unsatisfactory hours that I had passed in clinics as a child, were there
seemed to be a great deal to say about all aspects of my handicap except the
treatment of it. Yet this was the affliction of which Dr. Bronson Crothers, the
Harvard Neurologist and pediatrician has said: “It is probable that injury of
the central nervous system during birth, or immediately thereafter, accounts for
more than half of the deaths of viable babies. Furthermore, it is almost
certain that such injuries are responsible for the disability of more children
suffering from organic diseases of the nervous system than any other single
etiologic factor except infantile paralysis.” I decide then and there to devote
my attention mainly to the neglected therapeutic, educational, and vocational
aspects of the spastic problem.

On one of my visits to New York during this third year at
Yale I received further encouragement in my purpose. Somehow it occurred to me
to call up Dr.Frederick Tilney, who remembered me though five years had passed
since my interview with him, and insisted that I come to his office and let him
know how I was getting along. He congratulated me upon my remarkable physical
improvement and asked me about the library work at Princeton. I told him that I
had given that up some time ago and was now halfway through medical school.
When he heard why I wanted this training, he told me to come to him when I got
my medical degree and he would give me an opportunity to do clinical work with
spastics at the Neurological Institute in New York.

Doubtless Dr. Tilney took such an interest in me because
since his stroke he too had had handicaps to overcome. When I saw him, his
recovery at progressed to the point that he could walk, though with a limp, and
he had taught his left hand to do everything that his right had previously
performed. He told me that as a matter of fact he got more work done after his
stroke than be had before, and that the probable explanation was that he natural
left-handedness had been suppressed by training while a child.

This offer of Dr. Tilney’s was enough to sway the scale of
my fortunes. I had now passed all the requirements for admission to clinical
work at Yale, but the authorities of the medical school were somewhat doubtful
about letting me go on since they felt that my physical handicaps would bar me
from practice and would even prevent my getting hospital training after
graduation. Dr. Tilney’s offer helped to eliminate their objections, and I was
accepted as a regular student for the degree.

After being admitted to clinical work, I had another summer
at the Stillman’s Canadian camp. The strenuous outdoor life there was the best
sort of vacation from the intense mental activity demanded by medical school.
Bud and his mother were pleased that I was getting along so well, and Mrs.
Stillman insisted on backing me for the remaining two years of medical school.
She asked me how much I would need, not just to scrape along, but to have some
pleasure as well, and then gave me a generous allowance for the rest of my
medical school days.

The freedom from financial worries thus provided enabled me
to make the most of my last two years at Yale, and I had less difficult with my
work. Once I got my studies in hand, I joined a medical fraternity and enjoyed
a more normal social life. The dean happened to belong to the same fraternity,
and after I had known him as a pleasant social companion, he seemed much less
terrifying. As a result of my newly won sense of security and of fellowship
with the other medical students, I developed greater poise and social ease,
though these were still likely to desert me in moments of stress and
excitement. I can recall how at a lecture the man sitting next to me rapped my
kneecap – we had just learned how to test reflexes – and I promptly kicked over
the chair in front of me and it sent half a dozen others down like nine-pins
into the amphitheater pit. The confusion brought the lecture to a full stop,
and I suffered agonies for the next few minutes.

But I was doing my best now to avoid being crippled by
embarrassment, no matter what the circumstances, for I knew that in the work I
wanted to do it would be necessary to meet new situations and people calmly. In
the past I had always taken a front-row seat at lectures, because then my
attention was concentrated on the lecturer and I was not conscious of the rest
of the class. But now I tried to accustom myself to being in the midst of large
groups.

My difficulties with the clinical work were not as great as
I had anticipated. I found it easy enough to make examinations of patients
during ward rounds in comparative privacy with only a few other students about.
But I looked forward with some trepidation to the time when it would be
necessary for me to make an examination in the amphitheater before the whole
class. As matters turned out, this crisis was passed with the greatest ease. A
new professor was in charge, and he called upon the first name on his list,
which happened to be mine. I did not have time to become apprehensive, and went
down and put on a satisfactory demonstration. My attention was so concentrated
on what I had to do that my shortcomings were forgotten. This initial success
gave me confidence for the future, and whenever I started to feel apprehensive
in similar circumstances, I could overcome my misgivings by recalling it.

Dr. Phelps had already brought me into contact with the
clinical examinations of spastics, since he knew my purpose in studying
medicine; but now I had an opportunity to make a thorough study of an
interesting case, a seven-year-old boy who had been receiving treatment for
three years in the orthopedic section of New Haven Hospital and in the Yale
Psycho-clinic. Dr. Arnold Gesell, the director of the latter, came to the
conclusion that this mute and almost entirely helpless boy had an intelligence
commensurate with his age, despite his inability to walk, talk, and write. The
evidence provided by this case that mental growth can proceed without motor
experience encouraged my belief that the mental and physical training of
spastics should be carried on simultaneously, and that education should not be
deferred until the patient’s motor development was improved. Through social
contact with this child’s parents, I was able to supplement the findings I made
about him under clinical conditions, and thus gained some extremely valuable
insights into the problem of the treatment of the spastic.

It encouraged me to discover that I had less difficulty
with clinical work than some of my fellow students, whose ability to reel off
masses of facts had for outstripped mine when we were learning anatomy during
the pre-clinical course. At the end of his first two years, the medical student
has to adjust himself to working under new conditions. Instead of acquiring a
mastery of a more or less fixed body of facts and the ability to perform
experiments under carefully arranged circumstances, he must now select from his
store of knowledge the facts relevant to a situation which changes before his
eyes and whose origin is often shrouded in mystery. Diagnosis and methods of
treatment must be quickly chosen from a host of possibilities. Until experience
is acquired, the student’s perplexity is often extreme.

When I was on the accident service, and Italian child was
brought to the hospital in an unconscious state by a truck driver whose story
was that the boy had hailed him for a ride and keeled over shortly after
boarding the truck. We put the child on the examination table and were debating
which of the various possible factors might have produced unconsciousness. One
of us happened to lay a hand on the child’s distended abdomen. The child
promptly threw up and supplied all the evidence necessary to determine that his
condition was simple dead drunkenness brought on by too much red wine, which we
later learned he had consumed in his father’s cellar a few minutes before he had
hailed the truck driver. I regret to say that intoxication had never occurred
to any of us as a possible cause of his unconsciousness.

For a course in public health, which I took under a
prominent advocate of socialized medicine, I wrote a paper on the problem of
training the spastic, which I based on my study of Dr. Phelps’ and Dr. Gesell’s
case. The time and money expended in caring for this child had drained the
family’s resources and lessened its value to the community. Since treatment
would be necessary for many more years, the best solution for both the child and
its family would be institutionalization. But unfortunately there was
practically now provision for care of the multiple-handicapped. The child could
have been admitted to a school for the crippled if he had not been mute; to a
school for the dumb if he had not been crippled, or to an institution for the
feeble-minded if his freedom from mental defect had not been established. What
the child needed was a coordinated program of mental and physical training over
a long period of years. Such a program was beyond the means of his parents, and
of those of many other similar cases. Therefore, I came to the conclusion that
state and philanthropic sources should provide funds for the intuitional care of
the spastic. Through training a large number of such cases, commonly placed in
institutions for the feeble-minded and insane, could be made useful members of
the community instead of a permanent drain upon it.

Though this conclusion seemed inescapable to me then and
still does, I found when I started practice that there were all manner of
difficulties in establishing an integrated program which applied the resources
of both education and medicine to the spastic problem. The spastic should
receive such help as the various medical specialties can give to his
multiplicity of handicaps, and generally does, but it is infinitely harder for
him to get the education which may do still more for him. He is barred from the
public educational system, and yet the hospital where he receives medical care
feels that educational work is no part of its responsibility. Unless his family
possesses sufficient resources to afford the services of a private tutor, or he
is as fortunate as I was in being blessed with friends who opened the way to
education, he is denied the chance to overcome his handicaps through schooling.
There are adequate facilities in the hospitals in most of our larger cities for
diagnosing and prescribing treatment for the spastic, but the prescription is
one that cannot be filled without the help of a school program. The
establishment of special schools running in conjunction with the local board of
education where the mental and physical development can be simultaneously
controlled will enable the spastic to receive the prescribed treatment.

Shortly before the end of my fourth year in medical school
I received an invitation from Mrs. Stillman to come down to her place in
Pleasantville, New York, as soon as I finished my work. When I did so, I tried
to return to her a considerable sum which I had saved up during the year from
the allowance which she had provided. But she refused to accept it and told me
to use it for a trip abroad. She though I had been working too hard, and urged
me to spend the summer having a good time in this way. I had always wanted to
see the land from which my parents had come to America, and during the past year
I had entertained the hope of taking a year of study in Sweden on a fellowship.
That scheme had not worked out, but now I had a chance to spend a least some
weeks in the old country. I crossed the Atlantic in the company of a young
Swedish doctor who had been interning at New Haven, and then traveled through
Sweden, Denmark, and Germany by myself. I had hunted out the addresses of my
parents’ friends and relatives before I left, and now I called upon them. Far
up in northern Sweden, in the land of the midnight sun, I visited my father’s
brother and was received so hospitably that I wondered if my constitution would
survive the strain. After my first night there, I was aroused my aunt’s coming
in with a tray of coffee and cakes. After consuming these, I started to go out
for a walk, when she asked me if I were not going to have any breakfast, and
made me sit down at a table loaded with food. There was more coffee and cake at
eleven; then a big meal at noon, coffee and cake again at four; then a big
supper, and finally more coffee and cake just before bedtime. There was no
escape from all this eating and drinking; my aunt made it quite clear that her
feelings would be hurt if I slighted anything she had prepared.

Sometimes I had difficulty in convincing my relatives of my
identity. One of my mother’s sisters lived in a place so remote that she had
never seen a train or an automobile. My arrival in a car at her door created a
considerable stir, and when I tried to tell her who I was, she could not believe
that I was the poor crippled child of whom she had read in letters from America
long ago. She had assumed that I had died soon after my mother, since she had
heard nothing more of me since that time. When I succeeded in convincing her
that I was indeed her nephew, we went out for a ride in the car and for dinner.
Her enjoyment of the occasion was constantly interrupted by expressions of
amazement that she should encounter Maggie’s poor son under such circumstances.
I met with a similar reaction from other relatives, who found it strange that
their contact with members of the family who had gone to America should be
resumed through the appearance of the one least fitted for survival.

I had heard so much of Sweden and Swedish ways from my
parents and from Professor Stomberg at the University of Minnesota that I found
little in my travels that was completely unfamiliar to me. But there were
certain features of Swedish life, very different from American ways, that
appealed strongly to me. The immaculate cleanliness of the humblest restaurants
made a great impression on me. The people seemed to enjoy life a good deal more
than Americans, though they generally had less on which to do so. To one who
had always been oppressed by the rush and bustle of American cities, it was
pleasant to find a land where this was completely absent. No Swede would risk
breaking his neck in order to catch a streetcar; if he missed it, he would walk
calmly along until another appeared. The class distinctions were something new
to my experience, and I must often have violated Swedish Etiquette. I remember
one occasion when I transgressed in this respect. I was having difficulty in
getting my suitcase of a streetcar, and a policeman came to my rescue. He
insisted on carrying the bag to my destination some four blocks away, and was
highly insulted when I offered him a tip. He explained that he had helped me
because he wanted to do so, not because of the possibility of a reward, which
was beneath his dignity as an officer of the government.

At the University of Lund I looked up Dr. Sven Ingvar, whom
I had met through Dr. Burr when he lectured at Yale on his work on the basal
ganglia. It was with him that I had hoped to work if I had won a fellowship to
study abroad. He gave me a warm reception, and introduced me to several other
doctors who were working in the field which interested me. Dr. Ingvar reminded
me of Dr. Tilney in his ability to combine a large practice with important
research work. Both men were a type which is too rarely found in medicine
today. From this meeting I obtained an acquaintance with the trend of the
latest research on neurological problems.

I had booked passage home from Hamburg, so I had a few days
in Berlin and Hamburg before I sailed, which were enough to give me an intense
admiration for German medical research. The very quarters of the experimental
animals were better kept than many American hospitals, and this fact was just
one evidence of the thoroughness and attention to detail which characterized
German science. At the University Clinic in Hamburg I met Dr. A. Jakob, author
of an exhaustive work on the diseases of the basal ganglia. He showed me
experiments which he was conducting at the time on the relation of muscular
movements to these diseases, and when I told him of what I planned to do, he
offered the greatest encouragement.

After this summer, which had proved both pleasant and
profitable, I returned to New Haven for my final year of study. In addition to
my routine work I attended various conferences which promised to throw light on
some phase of the problem that concerned me. I have a vivid recollection of an
incident which occurred at one of these medical meetings. A famous speech
specialist asked the audience, which consisted largely of physicians who had
devoted their careers to speech disorders, if anyone had actually cured, not
merely helped, a stutterer. Not one of these specialists could give an
affirmative answer to the question. Whenever I was advised thereafter to give
up my plan of specializing in the treatment of spastics, since nothing much
could be done for them, I told that story and pointed out that, though a cure
was impossible, a great deal could be done to alleviate their difficulties and
to aid them to a better adjustment to life.

Another objection that I frequently encountered to my plans
was that there were not enough such cases to justify concentrating my attention
on them. I was told that the average practitioner saw only two or three such
cases in a lifetime. But I had the feeling that thousands of spastics never
came to the attention of doctors and that, if proper facilities for their
training were established, the extent of the problem would be revealed to be
much greater than was commonly held. Then again there were those who felt that
I would be like a blind man attempting to lead the blind. A baldheaded nose and
throat specialist, seeing me struggle as he swabbed my throat with iodine during
an illness, remarked that it was as absurd for me to think of helping the
spastic as it would be for him to specialize in the treatment of
baldheadedness. He, and many others, urged me to go into a field of medicine
unrelated to my own difficulties. I grew familiar with the stories of many
handicapped physicians who had found ways to be useful to society by
circumventing their handicaps. There was a blind hart specialist whose
overdeveloped sense of touch enabled him to make better diagnoses of heart
aliments through the use of his fingertips than an un-handicapped doctor. There
was a famous psychiatrist who treated his patients from a wheelchair. It was
suggested to me that X-ray diagnosis or the treatment of skin diseases were
fields of medicine in which I could work without suffering disadvantage from my
handicaps. But I could not be shaken in my conviction that my experience in
overcoming my difficulties would give me a special advantage in helping other
spastics to conquer theirs. I realized that my handicaps would offer obstacles
in the work I wanted to do; but there were plenty of people who refused to allow
a handicap to stand in the way of what they wanted to do. I had only to recall
the example of very eminent Harvard neurologist afflicted by a bad stammer, who
lectured to halls so packed that there was scarcely standing room. There would
be those who would find the text, “Physician heal thyself,” applicable to my
case; but I felt undismayed at the prospect of becoming too familiar with these
words.

The last few months of medical school fled by, and I did
better in my final examinations than my friends had anticipated. I had wanted
Bud Stillman to be on hand for my graduation, for I felt that he was in large
measure responsible for it, but he could not get away from Boston because of the
pressure of his own examinations. His wife came down, however, to see me
through my graduation day, and took me to Pleasantville, where Mrs. Stillman,
who had been divorced from Bud’s father, was to marry Fowler McCormick that same
week. While I was near New York, I visited Dr. Tilney and told him that I had
my medical degree. He congratulated me and said that he wanted me to take the
summer off and start work at the Institute on an extern fellowship that fall.
With that off my mind, I went up to Canada for a last summer of outdoor life
before I buckled down to practicing my profession.

During the summer and Grande Anse I had an
opportunity to familiarize myself with some of Dr. Tilney’s work. At the time
of her wedding to Fowler McCormick, Mrs. Stillman had given me Dr. Tilney’s
books, The Brain from Ape to Man and The Master of Destiny: A Biography
of the Brain. One sentence from the latter made a lasting
impression on me: “If, for example, Laura Bridgman, deprived as she was of
sight, hearing, taste, and smell, with only a fifth of her brain areas
accessible to satisfactory contacts with the world, made an adjustment to life
equal to the average of such adjustments; if Helen Keller, almost equally
deprived of sensory impression, is rated by many as belonging to the class of
genius; then the rank and file of mankind uses but a small fraction of its
potential brain power.” Since the spastic has far more contact with reality
than either Laura Bridgman or Helen Keller, he has a much better chance to
become a useful citizen.

When the cold weather began, about the first of
September, I left Canada for New
York. Dr. Tilney had reserved quarters for me in Bard Hall, the Columbia
College of Physicians and Surgeons dormitory, which was most convenient for me
since it was only a few steps from the Neurological Institute. This bit of
thoughtfulness was typical of the man. He also informed me that Mr. Stillman
had provided funds for my fellowship, on the grounds that he felt it was time
for him to take a hand in helping me to do the work I wanted to do. Once I
had brought down my belongings from New Haven and installed them in Bard Hall,
there was a month free before I was to begin work. So I went to Minneapolis
to visit Harold and to see Mrs. Herschal Jones, whose husband had recently
died, and other friends before I entered upon another new phase in my life. A
medical degree had been my goal for so long that, now it was attained, I felt
somewhat lost and was anxious to gain confidence from seeing familiar faces
and places.

But the process of adjustment to my new life was
easier than I had anticipated, mainly because of Dr. Tilney’s guidance and
encouragement. HE was one of those people who radiate cheerfulness and
strength, who make you feel better by their very existence. The amount of
work that he got through every day was tremendous. His office was filled with
patients all day, but somehow he managed to put in several hours of teaching
at the medical school and of research work in the laboratory.

His studies were devoted to the correlation of
behavior with the structural development of the brain. For this purpose he
had built up a collection of models of the brains of the opossum, the rat, the
guinea pig, the cat, and man. Many of the models were of embryo brains, so
that ht structural development could be studied at various stages. They had
been constructed after the following fashion: The brain was sliced into thin
sections, which were then mounted on slides and stained so that the various
nerve tracts differed in color. The slides were then studied under the
microscope, and the images projected on the wall. This enlargement was traced
on sheets of paper, which provided patterns for wax models. The data
furnished by these models was supplemented by the study of the behavior of
newborn infants, when the reactions are found in their greatest simplicity.
Such a procedure was necessary to his basic purpose of finding out why we
behave as we do, since the adult human reactions are difficult to analyze
because of their complexity.

One day when I was assisting Dr. Tilney in the
work with the models, he glanced out of the laboratory window and saw a
battleship moored in the Hudson
River. He remarked that if the amount of money which it took to build that
ship could be devoted to the study of the brain, we could achieve an
understanding of human behavior which would probably eliminate war. The funds
for research were limited to the point of crippling investigation while
millions were available for building instruments to destroy men.

My work with Dr. Tilney gave me the pint of view
that the disorders of the spastic should be studied form the point f view of
the structural development of the brain, rather than from his obvious muscular
handicaps. Observation of the normal child immediately after birth, during
his stay in the maternity nursery, and at intervals during his first two years
revealed that the uncoordinated movements are readily adopted to environmental
conditions. Correlation of these studies with the birth-injured might reveal
better means of adapting him to his handicap.

Most of my time was taken up, however, with ward
rounds, clinical conferences, and examining patients in the Vanderbilt
Clinic. I also attended the lectures on neurology and psychiatry for graduate
students. In the clinic, the term, “infantile cerebral palsy” was applied to
cases of muscular disorder arising from damage to the brain occurring before,
during or after birth. Such conditions are popularly known as spastic
paralysis, which is a term properly applied to one type of cerebral palsy.
For reasons of convenience, the term “spastic” has previously been used in
this book as synonymous with “cerebral palsied.”

The determination of the cause of such disorders
was often difficult, because any one of a number might be to blame. Faulty
obstetrics was often unjustly blamed for producing these conditions, as in the
case of identical twins whom I examined. Their disturbance of gait and speech
and their general lack of coordination were blamed on the fact that
instruments had been used in their delivery. Had only one twin survived, this
conclusion might have been tenable. But special X-rays of their heads taken
after removing cerebrospinal fluid and injecting air or oxygen
(encephalograms) revealed identical defects, and conclusive evidence was thus
provided that faulty development instead of birth injury was to blame.

Man is a continually changing organism, and this
change is most rapid from the time of his conception until his birth, During
the short span of nine months he develops from a single cell, infinitesimal in
weight, into the average seven-pound baby. But a slip in the building blocks
may produce a club foot, or as in the case of the twins, a brain defect. In
the latter, the amount of disability will depend upon the location and extent
of the faulty development. Should it be confined to an area of the brain that
is primarily concerned with muscular activity, the child will suffer no
greater mental handicap than the child with the club foot. Both must endure
the stigma of being “born that way,” as I did. But every man varies from his
fellows in some respect; and, in the last analysis, success or failure does
not depend upon what we lack but rather upon the use we make of what we have.

Hemorrhage in the brain at birth is the most
common cause of infantile cerebral palsy. It is known to have occurred in
normal delivery, in Caesarean birth, and in precipitate delivery, as well as
in labor accompanied by the use of instruments. My own handicaps were owing
to the use of forceps, whose mark I still bear on my skull. In precipitate
delivery the head is sometimes pushed through the birth canal with such
rapidity that there is no time for molding, and the over swollen blood vessels
burst. The delicacy of the blood-vessel system predisposes the premature
infant to brain hemorrhage. Prolonged interference with the fetal
circulation, such as occurs when the navel cord becomes twisted around the
neck, is known to have caused multiple hemorrhages of the brain.

King Richard III of England is thought to have been the victim of such
birth injuries. Sir Thomas More reports that “the Duchess of Gloucester had
much ado in her travail, being born the feet forward,” and in the soliloquy
assigned to Richard by Shakespeare there is a suggestion that premature
delivery was a factor:

I, that am curtailed of this
fair proportion,
Cheated of feature by dissembling nature,
Deform’d, unfinish’d, sent before my time
Into this breathing world, scarce half made up.

Another probable spastic in literature is the
crippled beggar in de Maupassant’s story,
Fecundity, whose mother died in labor. He is portrayed as one who
limps, blurts out words almost inarticulately, and has the appearance of an
idiot.

Many patients came to the clinic with a history
of infections, toxic factors, and hereditary degenerative diseases. In a few
cases tumor of the brain was revealed by examination. An infection shortly
after birth is more likely to have severe consequences than one which occurs
after the brain is more fully developed. Cerebral palsy resulting from toxic
factors, such as severe jaundice, which persists for several months after
birth, has a bad prognosis because the injury to the brain is more diffuse
than the common type. This should not be confused with the normal
physiological jaundice in the newborn, which is of short duration. I examined
a four-year-old boy, who had been as yellow as a Chinese four months after his
birth. He displayed a lack of concentration, and uncertainty in the use of
hands, feet, and speech. He showed no response to treatment, and, while there
was hope of helping him physically, there was little chance of mental
development. An example of the prospects in the case of hereditary
degenerative diseases was furnished by a seven-year-old girl, who was walking
unsteadily and able to go to school when first examined. Several other
members of the family had been similarly afflicted and had died. In spite of
treatment this girl became progressively worse, and in two years’ time was
completely helpless. The course of the disease is usually progressive in such
cases. Tumor of the brain should be diagnosed as soon as possible, for the
successful removal of the tumor depends upon early recognition, before its
early manifestation is obscured by muscle training.

In all cases, we found it essential to determine
whether the disease was progressive and what degree of mentality was present.
Evidence that the disease was progressive placed the case beyond the reach of
effective treatment; a profound degree of mental defectiveness excluded the
case because there was not undamaged residue with which to work. Before a
child was accepted for treatment and recommendations were made for his
education, he went through a very thorough examination to determine the type
of muscular disturbance, the severity of the damage to the brain, the degree
of intellectual impairment, and the degree of improvement that could be
expected.

In infantile cerebral palsy almost every
conceivable type of muscular disturbance or combinations of types may be
encountered. The chief types of muscular disorder are spasticity, athetosis,
chorea, ataxia, and tremor. Though these disorders re often grouped under the
term “spastic paralysis,” they are not really a true paralysis in the ordinary
sense of the word, implying loss of motion or sensation. Instead there is an
exaggerated motion, and often the musculature is surprisingly good.

Spasticity is a stiffness of movement. The limb
moves as a solid piece; the hand in attempting to grasp an object may remain
in a fixed position and is relaxed with difficulty. This condition is spoken
of as a springy or clasp-knife rigidity, because if the muscle is moved by
another person, a certain degree of resistance is encountered which is intense
at first and then diminishes rapidly as the range of movement increases, as in
opening a clasp-knife. In his early years the spastic cannot support himself,
and even if support is given, the rigidity of his legs prevents him from
walking. As time passes he may learn to walk after a fashion, and the gait is
quite characteristic – the toes scrape along the ground, the heels are not
brought down, and the spasm of the thigh muscles makes the legs cross at each
step in what is known as “scissors gait.” Speech is difficult, and not
infrequently profuse watering of the mouth and consequent drooling reflect
unfavorably on the mentality, which may be quite normal.

In contrast to the fixed type of rigidity just
described, athetosis (from the Greek, “without fixed position”) is a mobile
spasm which may occur either alone or in combination with spasticity.
Athetosis signifies involuntary, slow wiggling movements, like those of a
worm. It is a “plastic rather than a spastic rigidity”: The movement has no
spring to it, but rather a stiffness like that of very dense putty. Upon
attempted movement, there is an accompanying overflow reaction of the muscles,
causing the athetoid individual to exhibit writhing movements of the limbs and
the grimaces which resemble caricatures of normal facial expressions. In
athetosis the emotions exert a profound influence on the individual’s ability
to control his symptoms. Excitement and unpleasant emotional reactions
aggravate the condition, while a favorable environment and state of mind may
enable the athetoid to gain almost perfect control over his movements. Thus,
with the same individual, at one time the disturbance may not be apparent at
all, or may be limited to only one or two muscle groups, while at other times
the mere thought of attempting to move a finger may throw the whole body into
a chaos of writhing movements, with such violence that one would think that
the entire store of volitional impulses within the central nervous system had
been set loose.

Chorea may be described as an involuntary,
irregular jerkiness, such as characterizes the movements of a puppet. The
term comes from a Greek word meaning dance, and is particularly apt, since a
hopping gait is produced when the legs are affected. The popular term for
this disease, St. Vitus ’ dance, came into being in the fifteenth century, as
a result of an incident in Strasbourg,
Alsace. So many persons were afflicted with what was then known as the
“dancing sickness” and they caused so much excitement and disorder in the tow,
that the magistrate ordered them taken to the Chapel of St. Vitus in a nearby
village. The dancers accepted St. Vitus as their patron saint because of a
legend that just before he was beheaded during the persecution of Diocletian
in 303 A.D., he prayed that he might protect from the dancing mania all those
who should solemnize the day of his commemoration. While chorea is a disease
that generally occurs in children between six and the age of puberty, it is
sometimes congenital, and in such instances is usually associated with
athetosis.

Ataxia is a lack of balanced action between
opposing muscle groups, with a consequent clumsiness of movement. The ataxic
person suffers from slurring of speech, tremor, and rolling or staggering
gait, like that of a drunkard. The muscles tend to be more flaccid than
rigid. When asked to pick up a small object, the ataxic person brings his
hand down with a swoop – “like an eagle on a rabbit, “ in Charcot’s classic
description. There is a disordered sense of position: the ataxic individual
is not always aware of where his arms and legs are.

Tremor, or involuntary rhythmic trembling,
frequently accompanies spastic and athetoid conditions. If the tremor ceases
when the affected part of the body is at rest and reappears when movement is
undertaken, it is described as an intention tremor. Essential tremor, or
tremor of rest, is one which ceases on the carrying out of an intentional
act. I now of a surgeon with a tremor of rest that occurred in later life who
was able to perform skilled operations, although he could not keep his hands
still when he was not using them. The intention type of tremor is more
frequently encountered in infantile cerebral palsy than the tremor of rest.

When a single part of the body, as the foot or
arm, is affected, it is called a monoplegia. Hemipelgia means a paralysis of
one side of the body. Quadriplegia is a paralysis of all four limbs.

The significance of these various forms of
involuntary movement can be better appreciated through speculation on their
appearance in the lower animals. It is hypothesized that one of the
necessities of marine existence is constant automatic movement of fins or
extremities. The function of sending stimuli to cause such movements is
assigned to a nucleus of brain tissue that plays an important part in fish and
animals below them in the evolutionary scale. This nucleus, which is part of
the old brain, is also present in man. Upon acquiring a terrestrial habitat,
however, these continuous movements became unnecessary and even a hindrance,
so that a brake had to be applied to that part of the brain where they
originated. This brake action is assigned to the new brain or cortex, which
first appears in reptiles and reaches its highest development in man. The
movements of the normal human infant are uncoordinated and occur more or less
at random because the new brain has not yet reached a state of development in
which it can check the automatic action of the primitive brain. Therefore the
baby grimaces and drools and exhibit various movements suggestive of very mild
spastic and athetoid conditions, which subside as fuller cortical control is
established. At a later stage of development, phenomena of similar origin can
be found.

Verecellini cites the example of a normal boy
who attempts to write as well as he can. His hand is not as steady as that of
a fully grown man, because there is as yet no harmonious teamwork between the
incomplete functional development of the new brain and the already perfected
functions of the old. Despite this unsteadiness, the writing proceeds well
enough if he is undisturbed and not under the necessity of succeeding on the
first attempt. But if he is conscious of being watched critically and has
only one sheet of paper, he becomes tense and nervous, and finds the act of
writing more difficult than it really is. His face becomes flushed, and he
begins to tremble and sweat. The tension may reach a point where the emotions
gain complete control, and he abandons the attempt to write in rage and
tears. If eh does not thus give outright expression to his passion, more
intense flushing, twitching of the body and facial grimaces may occur. In
either case the delicate balance between the new brain and the old has been
disturbed, and the old brain has become dominant. Sometimes one of these
overflow movements which accompany the acquisition of a skill may persist long
after the skill has become second nature, as with the adult who sticks out the
tip of his tongue as he writes.

In the adult these biologically older mechanisms
are laid bare by disease or injury, or in moments of excessive strain. Dr.
Strong gave us a vivid illustration of this point in his lectures on anatomy
by showing pictures of the facial expression and hand positions of a pole
vaulter going over the bar, which were strikingly similar to those of an
athetoid, whose grimaces and splayed hands are due to birth injury. Dr.
Strong explained this similarity as being due to the fact that the pole
vaulter tries so hard to get over the bar that he exerts the full force of the
old brain as well as that of the new, with the result that the primitive
automatic responses of the former gain expression.

Dr. Tilney’s models clearly demonstrated that
the parts of the brain known as the frontal lobes reached their highest
development in man. Their function is to interpret and apply knowledge, to
understand a situation as a whole. Among those cases which I examined, those
whose freedom from damage to the frontal lobe was revealed by the
encephalogram showed a greater determination to overcome their physical
handicap and a better response to treatment. In one twelve-year-old boy who could not walk or talk,
the X-rays showed severe damage to the brain but none to the frontal lobe. He
was so slightly handicapped physically that he had been admitted to regular
school. He displayed a good memory for isolated facts, but filed when he
reached a grade where he was expected to combine ideas. In behavior he
displayed a lack of judgment and reserve and a tendency to foolish
cheerfulness, which made it impossible for him to profit from treatment. As I
correlated these two cases with Dr. Tilney’s studies, I realized the severity
of the physical handicap was a poor criterion of the spastic’s fate, and that
a study of his behavior in relation to the structural brain defect gave a much
better idea of the prospects of helping him.

In the work at the Neurology Department of the Vanderbilt
Clinic I found it discouraging that so little could be done beyond making a
diagnosis and discussing the future prospects of the case. Hundreds of the
cerebral palsy cases I examined had received no training, though many of the
patients were thirteen or fourteen years old. This was tragic; for, unless
treatment started at an early age, wrong motion habits become too firmly
established to be eliminated. And such cases have a tendency to become
neurotic, even psychotic, unless they receive careful guidance in adjusting to
their handicap.

Their lack of self-discipline was clearly evident when they
came to the clinic for examination. Almost invariably they were highly excited,
and their parents would assure me that I was getting a poor impression of them –
Johnny or Betty was much better behaved at home. Neither parents nor children
realized that I understood the difficulty, having often been rendered helpless
myself when thrust into new situations. The examinations were conducted under a
stream of admonitions from the parent to the child to stop drooling, to sit up
properly, to stop squirming. Such suggestions, of course, did nothing to
improve the child’s behavior; they made him more self-conscious. I would ask
the mother if she could think about breathing without finding that her rate of
respiration was upset, or about her mouth watering without finding it necessary
to swallow. Invariably she found that she could not, and thus she came to
understand that the spastic is exceptionally subject to suggestion and that it
is important to avoid drawing his attention to his difficulty. The simplest
muscular act demands from him the same concentration that a normal man would
bring to bear in learning to walk the tight rope, and diverting his attention is
like attempting to draw the tight-rope walker into conversation.

From my own experience I knew that the best way to put the
child at his ease was to get him to recall some pleasant association, so I would
ask him if he had a cat or dog at home and get him to talk about that while I
went on with the examination. The parents were amazed to see how the child
quieted down at once, and wondered why they had never thought of so simple an
idea. Since we had no facilities at that time for muscle training or
educational activities the best I could do was offer a few suggestions which the
parents could apply at home. Among them were to interest the child in what he
was doing; in walking to get him to look where he was going; in shaking hands,
at the hand he desired to grasp, and in speech, at the lips of the person to
whom he was speaking. It was surprising how much progress was brought about in
some cases through such simple means.

There were so many cases of cerebral palsy that I was kept
very busy. It was a far cry from the “two or three cases in a lifetime” which
some of my advisers at Yale had suggested. Making examinations and writing up
case histories, which was a severe chore for me, took up all my time. But from
day to day I grew more convinced of the necessity of a broader treatment than
was then possible. It seemed useless to make thorough examinations of these
cases when we had no opportunity to help them through muscle training and
education. My little lectures to the parents seemed a pitifully inadequate sort
of treatment. Only the wealthy could afford the services of a technician
especially trained in treating these conditions, and there was none on the staff
of the neurology division of the clinic.

Dr. Tilney’s answer to my complaints on this score was to
let me see some cases in which the parents’ means were adequate to meet the cost
of a technician. I found a therapist who was adequately trained for work with
the birth-injured, and her treatment of one little girl produced such good
results that I kept a moving-picture record of the child’s progress. Here was
proof of what therapy could do, and more than ever I wanted the services of a
muscle trainer in the clinic. I finally induced the therapist to give her
services or one afternoon a week, since the Neurological Institute had no funds
available for this purpose. Under this arrangement it was possible to do little
more than to prescribe a set of exercises for the patient and demonstrate to the
mother how they should be performed at home. But even under these conditions
some of the cases showed so much improvement that I later found it possible to
enlist Dr. Tilney’s support for a further extension of the work. A private
clinic was established on the seventh floor of the Neurological Institute with a
full-time therapist, and examinations to determine the nature and the extent of
the difficulty could be followed up by muscle training especially adapted to the
needs of the particular case.

The value of muscle training depends upon a number of
factors. Before the exercises are started there should be a preliminary
relaxation period. A calm and quiet atmosphere is essential, and the teacher
should be a person with a temperament and a personality conducive to
relaxation. The chief aim of the exercises is to teach the patient to make each
active movement with a minimum of muscular effort. With younger children it is
necessary to assist them passively until they are able to carry out the
movements by themselves. This ability is built up by daily repetition of the
movements. As a rule it is better at first to allow the child to do the
exercises as best he can, though erroneous and unessential movements may
accompany the first attempts. Later the incorrect movements may be gradually
eliminated.

It is very important to determine which type of muscular
disorder is predominant, for the treatment of athetosis is quite different form
that of spasticity and ataxia. Therefore, the physical trainer should be guided
by a medical diagnosis. The technician should be present when the examination
is made or have a good record of which muscles are strong and dominating in
tension and which ones are weak.

In the normal person, when the arm is hanging quietly by
the side, it may be said for the purpose of explanation, the tension of the
flexor muscles of the elbow is at par with the tension of the extensors. When
the tension of the flexors does dominate, the arm bends upward. The flexors
shorten and the extensors stretch as the movement progresses. In ataxia there
is a lack of balanced action between opposing muscle groups. Instead of there
being a definite enhancement of tension in the flexors and a definite diminution
of tension in the extensors to produce the smooth, sweeping, continuous movement
we see in the normal when he raises the hand to the face, there is a generalized
diminution of muscle tension and strength with the result that the movement is
done jerkily. This unsteadiness can often be overcome when somebody lends only
slight assistance, like placing the hand lightly on the arm as the patient makes
a movement. An ataxic who reeled drunkenly when he attempted to walk by himself
required only slight support of a trainer to walk normally. Since the cortex
plays the most important part in voluntary movement, it can be trained to
compensate in large measure for the defects in the brain that give rise to
ataxia. Such training places a great deal of reliance on vision. The ataxic
must look where he walks or focus on the object he is attempting to reach.

In spastic conditions the flexor muscles are usually more
powerful than the extensors, and the thigh muscles which bring the legs together
are stronger than the opposing groups. This is why the legs become crossed on
each other when the spastic attempts to walk. When the spastic flexes a limb,
there is usually a powerful simultaneous contraction of both extensors and
flexors, and the limb becomes rigid. Treatment attempts to overcome this
condition by teaching the patient to relax one set of muscles as the opposing
muscle group is brought into action. The child with the scissors gait, for
instance, is taught to spread his legs apart after he has relaxed the muscles
that keep them crossed. This is usually done while he is on the treatment table
or in the pool. The child spreads his legs apart with as little assistance form
the trainer as possible, and the trainer then brings them together when the
child relaxes. The trainer must not be discouraged – it often requires a long
time before the child learns to relax individual muscle groups satisfactorily.
In spastic conditions the degree of rigidity decreases as the range of motion of
the spastic member increases and it is advisable to begin training of the larger
muscle groups first and to defer training of the smaller groups until control
has been established in the former. If it is necessary to stretch a tight
muscle group, it should be done gently and when the patient is relaxed, to avoid
any muscle spasm. The application of heat and a gentle massage is sometimes
helpful for producing relaxation. Stimulating massage is contra-indicated
because it increases muscle tension. Sunlight is supposed to increase muscle
tension, but I have seen no deleterious effects from it. In fact, the general
benefits derived from sunlight are so great as to offset any increased tension
that may occur before the spastic becomes acclimated to it.

Behavior problems often interfere with successful
treatment. A spastic who was prone to show an attitude of foolish cheerfulness
toward treatment began to realize the importance of exercises when he developed
an interest in helping a girl who could not walk. Great resistance to exercises
is usually encountered in the spastic with superior intelligence. He likes to
daydream instead of exercising. A girl of seven who was in the fourth grade in
school required six months to show any active degree of co-operation. AT the
time I first examined her, she held her legs rigidly and was scarcely able to
move one in front of the other when she was held supported under the arms. Her
speech was good, and she had fair control of her hands. She became interested
in exercises simultaneously with a desire to ride a tricycle. The latter was a
feat she felt she could accomplish sooner than learning to walk. She learned to
ride a tricycle in a short time and later was able to walk with the aid of
crutches.

The athetoid is not the daydreamer that the spastic is. He
is eager to co-operate and is not as easily discouraged. Fear, anxiety, and
self-consciousness aggravate his writing movements, while agreeable emotional
reactions enable him to gain almost perfect control of bodily movements. The
public speaker and the athetoid have much in common. Both are helped by
exercises that teach relaxation; but such measures are useless to the public
speaker in overcoming stage fright if he has forgotten what he is to say, and
are equally ineffective in helping the athetoid if he is unable to forget
himself in his work. Treatments should, therefore, be directed toward keeping
the athetoid occupied and at the same time keeping his mind off his muscles.
This can be done by directing his attention to the purpose of the act rather
than to the muscles which perform it.

It is, of course, very difficult to lay down or prescribe
any one set of rules for specific types of exercises, especially since
combinations of motor disability occur more frequently than does a pure type of
motor disturbance. It must furthermore be remembered that the individual is
born that way. His motor disturbance is, in fact, so intimately tied up with
his mental and emotional processes that it is as difficult to conceive of the
abnormal movements as being something apart form his feelings as it is to think
of a smile as being something separate from the thought which evoked the smile.
The muscles should, therefore, not be treated as if they were independent from
the rest of the body.

The treatment room should contain practical and attractive
furnishings. A child is less apprehensive about falling when he is treated on a
wide table. Mechanical apparatus for exercising are of little value. A
stationary bicycle may sometimes prove useful. The Adirondack style of
armchair, with its inclined seat in which a child fits snugly, is helpful in
teaching a child to sit alone. If the sides of the chair are fitted with boards
sloping outward at a thirty-degree angle, they will prevent the child’s head
from falling over the edge of the chair. When such a chair is fastened by means
of hooks to a sturdy table built with elevated edges to prevent toys from
falling, a seriously handicapped child will often be able to do more for himself
than when he is held in the arms of an attendant. Even before the child
acquires ability to hold an object, toys should be put into his hands, so that
he may get as much as possible of that type of mental development which proceeds
by grasp and touch in every normal child. As he learns to associate the object
by name and one toy still holds his attention more than another, there will be a
corresponding decrease in disorganized activity.

Parallel bars, chalk lines on the floor, and mirrors on the
walls of the treatment room help the child to guide his motions with his eyes.
Such apparatus must not be relied on entirely, or the child will find it
difficult to control his movements when he is not in the treatment room. Before
the exercises have been repeated a sufficient number of times to become
automatic – that is, so that they can be done with the least amount of conscious
effort – the child will do badly in situations where he is easily distracted.
To help him on such occasions he must learn to inhibit the sensory stimuli which
are irrelevant to his activities. When he is walking on the street, looking
along a crack in the sidewalk will direct his attention to where he is going.
When he finds his bodily reactions are about to end in a whirl of confusion, he
should stop everything and think. I have frequently seen a frustrated child
attain relaxation when the teacher has directed his attention to a card on which
was printed the word, THINK. Recalling a picture that he has seen duding
moments of relaxation will help a child to gain control over his movements.
This is why it is important to have interesting pictures on display in the
treatment room. Pictures of subjects in repose have a relaxing effect on some
children, while in other cases a picture that portrays action is better in
helping the child to collect his thoughts when his muscles seem to be getting
the best of him. A picture of a hunter killing a bear that hung in my uncle’s
living room helped me to overcome the fear of having my face shaved. I used to
imagine the barber’s hand was as jerky as mine, and I would go into a panic
whenever he came near me with the razor. When my friends heard of my dilemma,
they teased me by tying me to a tree and pointing knives at me. The more I
screamed and squirmed, the more they enjoyed the prank. One day when they were
wielding their knives at me I tried to forget my fear by thinking of the picture
in my uncle’s living room. I imagined I was the hunter and concentrated on
killing the bear. As I did this my squirming movements suddenly ceased, and the
boys were amazed to see that I was no longer afraid. I subsequently learned to
relax in a barber’s chair without thinking about anything in particular.

The principal of working from the larger to the smaller
muscle groups was upset when I encountered a spastic girl who was unable to feed
herself, but could play the piano beautifully. I found an explanation for this
phenomenon in a report by Dr. Brickner and Dr. Lyons on the case of a man who
had been a star pitcher for the New York Giants before he contracted sleeping
sickness. He was able to walk only with difficulty, and all his motions were
retarded. In their test the man stood on the hospital lawn, with stooped head
and shoulders and trembling hands, in an attitude of rigidity and immobility.
When a baseball was thrown to him, his whole body immediately became plastic, he
made a perfect catch, and at once threw the ball back with all his former skill
and grace. It occurred to me that there might be a common factor in the ability
of the pitcher to recall a familiar acquired skill and of the spastic girl to
acquire a skilled act, and I found it in interest. At mealtime the girl was too
conscious of her unruly muscles to be able to control them, abut when she lost
herself in music she played without conscious effort, just as my overpowering
interest in the runaway horses had enabled me to take my first unsupported
steps. The elimination of emotional factors, such as anxiety, fear, and
self-consciousness, from the muscular act by developing the patient’s interest
in what he is doing often does more for his physical development than any amount
of conscious muscle training.

Occupational therapy is one excellent way of arousing the
patient’s interest. Those children who received training in basketry, weaving,
and woodworking in the occupational therapy department of the clinic evidenced a
remarkable improvement in muscular control. One girl, so athetoid that she was
unable to bring her arms together, learned to knit when her wrists were tied so
that they could not fly apart. Another athetoid was able to weave and paint
when her unruly arms were controlled by bandages wrapped around the elbows. A
boy whose right hand was usually extended at shoulder level became so interested
in manual training that he was able to wield a mallet accurately with this
hand. Children who soon became bored with their exercises, with moving their
muscles simply for the sake of moving their muscles, delighted in using their
hands purposefully and soon won much better control over them.

From time to time Dr. Tilney would ask me how the children
were responding to physical training, and I replied that some showed remarkable
response to the exercises, while others gained little benefit from the
repetition of movements. He called my attention to Dr. McGraw’s finding, in her
study of normal human behavior during the first two years of life, that
repetition of an activity during certain stages of development does not
establish improved performance. Stepping movements show themselves almost
immediately upon birth, but no amount of exercise is going to enable the normal
infant to walk until his nervous system has attained sufficient growth, which
usually occurs at the age of about one year. The physical improvement that is
possible through exercise for the cerebral palsied person depends upon growth
factors. In one child the structural development of the brain may be arrested
as far as motor abilities are concerned, and the repetition of a physical act
will result in no improvement, while in another there may be unlimited
possibilities of developing muscular control. The mother who ties up the good
hand of the hemiplegic child, thinking that the more he uses the maimed member,
the sooner he will become normal, often creates speech disorders and behavior
difficulties which are far more serious than the original difficulty. The
paralyzed arm should not be neglected as far as treatment is concerned, but
attention should not be concentrated upon it.

In the normal as well as in the spastic, emotional factors
have a tendency to increase muscular tension and thus affect posture and
movements. Many of the children brought to the clinic for muscle training were
so petrified with fear in their new surroundings that they could not co-operate,
although at home they enjoyed doing the few simple exercises we were able to
teach the mothers. Fear exerts an inhibitory influence on motor activity, and
with the cerebral palsied there is a constant conflict between the desire to
make a movement and the recollection of having failed to make it successfully in
the past. This difficulty can often be overcome by psychological means. A
spastic athetoid girl was afflicted with an uncontrollable twitching of the eye
muscles which became particularly acute when she was conscious of other people
noticing it. I urged her to wear dark glasses, and when she had thus lost her
fear of attracting attention, the twitching ceased. Another girl whose facial
grimaces made her speech difficult to understand found herself able to speak
clearly when she wore a mask at a costume party. In both cases the discovery
that the difficulty was not unconquerable, but largely the result of
self-consciousness, made it possible for the patient to overcome it. While it
is true that the cerebral palsy’s difficulties are primarily due to an injury of
the brain, the psychological element is so important that the physical
difficulties may be minimized by increasing his assurance and self-confidence.

While surgery offers no cure for cerebral palsy, operations
have been devised for particular objectives which often help along a program of
muscle training. It used to be thought that the sympathetic nervous system
governed the state of tension in the muscles, but the Hunter and Royal operation
on this system has been of little value according to the consensus of opinion.
Splendid results are often obtained from muscle transplants, nerve suture,
tenotomies, and alcoholic nerve injections, when these procedures are followed
up by a thorough program of exercises. Operations on the brain or spinal cord
decrease involuntary movements in any cases. In nearly half of the cerebral
palsy cases, the eye muscles are affected. Since in training a great deal of
reliance in placed on the co-ordination of vision with muscular movements,
surgical correction of cross-eyedness will often bring about a remarkable
improvement in the general condition. I recall the case of a cross-eyed ataxic
boy who was able to maintain his balance, but could not walk at all, when I
first examined him. Two weeks after the eye condition had been corrected by an
operation, I saw him again and he was walking, because he could now use his eyes
to guide his steps.

Many of the parents who brought their children to the
clinic expected that medicine would be prescribed. But in these conditions
drugs are mere palliatives because of their transitory effect. Sedatives, such
as luminal and bromides, should not be used except in cases of convulsive
disorders. Any drug which tends to depress the mental activity makes the
patient less responsive to treatment, and a cup of coffee will often do more
good than a sedative. Alcohol temporarily eliminates the uncontrollable
movements but should not be resorted to frequently because of its habit-forming
tendencies, though it may be useful upon occasion. I recall one instance when
the mother of a cerebral palsied child telephoned me for advice from a dentist’s
office, where the child was writhing about in the chair in such a way as to make
removal of a tooth impossible. I suggested administering a glass of sherry, and
I later learned that the tooth was removed without any difficulty. Spasticity
may also be lost for a short period after recovery from ether anesthesia. One
mother told me that the first time she had ever been able to understand the
speech of her spastic child was when the child was coming out of the ether after
a tonsillectomy. As the ether wore off, the child’s words became less and less
distinct, and finally his speech was as poor as before the operation.

Convulsions are sometimes encountered in cerebral palsy,
and occur most frequently in hemiplegics cases. Every convulsive child should
receive all the tests necessary to determine the factors which produce
convulsions. Surgery is sometimes indicated. The general everyday care of the
spastic with convulsions is important. Fatigue and all unnecessary excitement
should be avoided. No stimulants such as tea, coffee, or chocolate should be
given. The attacks are closely related to constipation, and the bowels should
be kept open by suitable means. The child may be sensitive to certain foods
that precipitate attacks. Convulsions sometimes cease at adolescence or with
the onset of menstruation. The attacks frequently disappear when the child is
placed in an environment governed by a regular routine, but may return in a less
settled one. A diet high in fats and low in sugar content, and restriction of
fluid intake are beneficial in some cases. The attacks may be set off by a low
blood sugar. Such attacks usually occur in the early morning before breakfast.
Combination of thyroid and luminal has been used with some success in relieving
convulsions. A new treatment for convulsions has been discovered which employs
the drug Dilantin. This drug is particularly valuable because it diminishes the
attacks without giving rise to drowsiness as other sedatives do.

Experiments are now being made with snake venom, bee venom,
and curare, a South American Indian arrow poison, which produce partial relief
of muscular tension for a short time but seem to have no permanent effect.

Feeding difficulties occur in all cerebral palsies.
Inability to suckle shortly after birth may require the use of a medicine
dropper in giving milk to the infant and is one of the early signs of birth
injury. Antispasmodic drugs may be necessary to relax the muscles of the
digestive tract. A hyperactive gag reflex may cause vomiting when solid foods
are introduced. It subsides if the situation is handled in a matter-of-fact
way. If the child is made the center of attention he is likely to acquire the
habit of vomiting whenever he feels neglected. He sometimes refuses food for
similar reasons. A spastic who had to be hospitalized on this account was
broken of the habit when the nurse gave his plate to another child when he
refused to eat. He ate the next meal without a temper tantrum.

Bronchial and asthmatic attacks occur frequently in
cerebral palsy cases. They usually subside when the child is placed on a
regular routine and seem to be related more to the emotional disturbance than to
an allergic condition.

Mothers who brought spastics to the clinics were surprised
to learn how easy it was to teach a child to feed himself. If it was at all
within the child’s ability to bring his hand to his mouth, he was encouraged to
feed himself. This can be accomplished by using a deep dish with vertical
edges, placing it in a plank of wood in which a hold to fit the dish has been
made. When the child feels there is no danger of pushing over the dish, he will
be less apprehensive. Placing a rubber coin-change mat under the dish will also
keep it in place. A dish with a rubber suction cup that prevents it from being
pushed off the table is on the market. A spastic can handle a glass of water
with ice in it better than he can manage a glass without the ice. Anyone who
has eaten on a Pullman diner when the train takes a curve has observed that the
coffee spills more easily than does the water with ice in it.

It was pitiful to see mothers bringing older children to
the clinic who had not been trained in toilet habits. If the child shows any
mentality al all, it is possible to train him by using a comfortable toilet seat
on which he feels secure. The trouble is the child cannot relax sufficiently to
empty the bladder or move the bowel when somebody is required to hold him on the
seat. Then when he gets to bed a he relaxes, the accident happens. The child
should be left alone on the toilet the same time each day and not be removed
until he is finished even if he cries during the first attempt.

The frequent sipping of fruit juices or chewing gum will
help to overcome drooling. The spastic has difficulty doing two things at the
same time, such as swallowing and using the hands. The child may require so
much effort and concentration for using the hands or walking that the saliva
fails to evoke the reflex of swallowing and dribbles down the chin. Excessive
salivation ceases as the child becomes accustomed to tending to several things
simultaneously without directing attention to drooling.

Sometimes it was possible to improve the patient’s muscular
control by prescribing braces or special shoes. In severe athetosis and
spasticity, braces often do more harm than good, while in milder cases they may
be of great benefit. Braces that guide the legs in the correct motion patterns
are important in teaching the child to walk. They also be used to advantage at
night to keep the muscles in normal position during sleep. One child who had
been unable to write learned to do so almost immediately after being fitted with
leg braces. The braces held his unruly legs still and brought about an
unexpected improvement in his control of his hands and in his speech. Similar
results often follow surgical procedures which relieve tension in a single
muscle group. Where there is a tight heel cord, high-heeled shoes will often
prevent the occurrence of deformities in other parts of the body, as may happen
when the cord is kept stretched by the use of a low heel. High shoes are
invariably better than low ones, because the spastic has weak ankles which are
apt to become deformed unless supported. Girls who are reluctant to wear high
shoes because of their unstylish appearance may use ankle supporters beneath
their stockings.

With those children who had difficulty in walking, I
suggested various practical principles that the parents could put into force at
home. Pushing a baby carriage and walking between parallel bars help the child
to maintain his balance by looking where he is going. The use of canes and
crutches are helpful. If the child is so unsteady on his feet that a walker is
necessary, it should be so designed that he must push it in the direction in
which he is looking. I urged the mothers to avoid giving the child a faulty
sense of balance by supporting him from behind when teaching him to walk. He
must learn to go forward rather than backward when falling, and it is often
better to let him acquire the experience of falling than to guard him too
carefully from it. Outdoors, grass or sand will save him from injury, while
indoors a mat may be used. Through experience he will learn to reserve his
sense of balance. If walking is delayed too long, it will become a more
difficult matter than if it is acquired during the period of development, when
the center of balance is constantly changing with growth. McGraw cites the case
of normal twins who learned to roller skate at a very early age but lost this
ability after being off the skates for six months. During that period they had
brown so rapidly that they had to adjust themselves to another center of gravity
when they were again placed on skates.

I constantly had to warn parents against lavishing praise
on their children when they took their first unsupported steps. The child is
apt to attach too much importance to the newly acquired act, and to become
afraid of spoiling his record by later unsuccessful attempts, and thus normal
development of the ability is interfered with by emotional factors. There was
one striking example of this in the clinic. The child had learned to walk under
our guidance. Then his mother took him away from the city for six months. When
they returned, she brought him in to see me and said that he was no longer able
to walk. I had a notion of what was wrong, and told the child to walk across
the room. He did so successfully until his mother stared to praise him for what
he had done. The child became emotionally upset and consequently lost control
over his motions. To avoid this, it is better to wait two or three days after
the child has acquired anew skill before praising him.

It is said that we learn to skate in the summer and to swim
in the winter. This saying might well be taken to heart by the spastic, who is
likely to feel that his exercises have no relation to reality during a long
period of muscle training. Since he derives no benefit from exercises when he
performs them in this mood, it is better to suspend them for the time being.
But often he will find that he can do normal acts which were impossible for him
before he stared the muscle training. When I saw the physical improvement
brought about through occupational therapy, I wished that the children who came
to the clinic had the same opportunities to put their training into practice as
I had had at the Stillman camp. The difference between the very must muscle
training and the use of the muscles in the practical activities of everyday life
is as great as that between setting-up exercises and participation in
competitive sports.

Parents are frequently more grateful to the physician when
he prescribes a pill that temporarily improves the spastic than when he spends
hours in discussions about the importance of exercises and education. It is the
general disinclination of the spastic to depart from the path of least effort
that has made his progress so slow. If involuntary movements can be temporarily
abolished by suing drugs, then other means giving lasting results should be
possible. The answer lies in education. But real education implies real hard
work and perseverance. It is not so much the teacher or the trainer that
counts, as the efforts made by the spastic.

My first few months at the Institute confirmed my belief that the answer to the
spastic problem was not simply a matter of physical therapy. The traditional
view was that a crippled child could not develop mentally beyond the limits of
his motor experience, since he had to translate ideas into muscular activity in
order to grasp them, and that therefore the first object in treating a spastic
was to educate his muscles until some control had been obtained. The question
of academic training was put off until this goal was attained or neglected
entirely. But I believed that the mental growth brought about through academic
training promoted an improvement of physical control, or at least developed the
ability to circumvent the physical difficulty. In some cases I found there was
definite physical improvement through academic education unaccompanied by
physical therapy.

A most remarkable example was furnished by a young man who
came to see me in the summer of 1932. His name was Theodore A. Bretscher, and
he had just obtained the degree of doctor of philosophy from the University of
Cincinnati, despite his very severe physical handicaps. He had learned to walk
when he was six years old, and had passed through the first and second grades of
school. Then a setback prevented him from walking again until he was twelve,
and his family gave up the idea of further schooling for him. At twenty he was
selling newspapers on the street and was unable to read or write. He determined
to educate himself, and with the aid of a kindly librarian and many hours in the
public reading rooms, he succeeded so well that he was finally admitted to the
university as an auditor, since he had no credits for grade or high school
work. After four years the authorities decided that he could be accepted as a
regular student and receive credit for courses, though he was still physically
unable to write and had to dictate his class work. He took his A.B. degree in
1928 and his A.M. in the following year. An appointment as a graduate assistant
in the department of philosophy enabled him to complete his work for the
doctorate in the usual period of time. He emerged with great success from a
two-hour oral examination, having received tributes from his examiners on the
breadth and solidity of his scholarly attainments and on his capacity for clear
and original thought. His grades were all A’s with the exception of one C. In
addition to his academic work he had contributed a paper to the PsychologicalReview, one of the outstanding journals in that field, and a number of
articles to the book page of the Cincinnati Times-Star.

During his ten years at the university his ability to walk,
use his hands, and talk clearly improved steadily and noticeably. One
instructor who had known him as an undergraduate did not recognize him when they
met again in the graduate school, so great had been the improvement. While at
the beginning of his university career he had been completely dependent upon the
care of his sister, at the end he was able to take care of himself and live
alone. He came to me for advice about his vocational problem, for he found that
prospective employers were too repelled by his obvious handicaps to recognize
his abilities. He did not wish to rest upon the remarkable record he had made,
but was anxious to make remunerative use of the mental equipment which he had
developed so painstakingly. I was glad to be able to place him in a practicable
line of work, through the help of Dr. Tilney, and to give him what therapeutic
assistance I could.

Dr. Bretscher’s history confirmed my notion about the
importance of academic education for spastics. As I told him, the real tragedy
of the spastic is that his physical lack of control suggests a lack of mental
balance, for the body may completely belie the intelligence it harbors. He had
an unfortunate proof of this statement one day, when I asked him to meet me at a
clinical conference in the Psychiatric Institute. Two attendants saw him,
decided that he was an escaped inmate, and put him under restraint. The
excitement rendered him unable to give a coherent account of himself, and the
situation was not straightened out until the arrival of a doctor who knew him.
I myself have had similar experiences, and heard of many more in my practice.
But the deceptive character of physical appearance is not confined to spastics.
I remember another clinic attended by a number of distinguished neurologists,
including two strangers. The staff of the clinic all happened to be handicapped
in one way or another: one limped as result of cerebral palsy, another wore a
brace, and third wobbled about on crutches as a result of infantile paralysis, a
fourth had a tic in his shoulder and was deaf as a post. There was a delay in
the arrival of the patients who were to be examined, and one stranger turned to
the other and said, as he pointed to his fellow specialists, “What are we
waiting for? The patients seem to be on hand.”

Too frequently the spastic is barred from school, even if
his handicaps permit him to reach it, on the grounds that his presence will
upset the class. In New York City, the Board of Education provided home
teachers for those cripples who could not walk; but this arrangement was not
satisfactory from my point of view, since the child had no competition, and
hence no chance to attain the psychologically vital sense of personal worth.
Also he had no opportunity to accustom himself to the new situations that eh
must encounter some day. And, finally, these home teachers were available only
for children over six years old; and with the spastic it is important to start
training at a much earlier age. Lacking adequate means of expression, the
sounds mind behind the crippled body will also become crippled. It is an
overflow of energy that causes many of his difficulties. Given the opportunity
for education, he can divert some of this energy into mental channels, with a
consequent improvement of his physical abilities. Indeed, the fate of the
patient depends upon the use of this overflow. Either it is directed through
practical training and put to use in such a way as to help the spastic to find a
place in the social order, or else he is destined to remain an unhappy stranger
to himself as well as to society. What the patient will be able to do with his
excess energy in the way of creating a philosophy and finding a way of life
which will lead to the realization of this philosophy depends upon his mental
endowment, his moral character, and the opportunity which society is willing to
give him.

I talked over the problem with Dr. Tilney, and as usual he
helped me to a solution. I told him that I did not want the clinic to become
just another physical therapy department, but rather a center where the
birth-injured child could be taught to adjust his behavior as adequately as
possible within the limits of his abnormal structural development. The clinic
as I saw it would be a parallel to Dr. McGraw’s Normal Child Guidance Clinic,
whose findings helped the normal child to adjust to his constantly changing
environment. The spastic is ordinarily a badly spoiled child, completely
lacking is self-discipline and the power of concentration. Yet it is only
through acquiring these qualities that he can overcome his handicap. A school
program was obviously the best way of developing them, and it also provided an
excellent means of taking the child’s mind off his difficulties and thus
increasing the benefit he obtained from physical therapy.

Through the help of Dr. Tilney and the director of the
social service department, the Institute was induced to provide space and
equipment for such a school. The Board of Education was glad to supply the
services of a teacher, since the scheme relived them of the necessity of sending
a teacher to each child’s home. A definite daily routine of simultaneous mental
and physical training was adopted. One hour was allotted to muscle training,
followed by an hour of rest, and during the remainder of the day the children
were kept occupied by studies and such games as tended to develop
co-ordination. Occupational therapy was provided once a week. A close contact
was kept with the home to make certain that the parents were cooperating in the
program which was designed to make the child self-dependent. This was necessary
in order that the emphasis on discipline and regular routine at the school might
not be offset by home influences. I observed that we obtained the best results
with those children who lived at the hospital, and thus had no distraction from
the regular routine. But of course residence at the hospital was out the
question for the majority of cases because of the expense, and the parents had
to bring the children to the hospital every morning and call for them in the
afternoon. Eventually the Board of Education provided a school bus, which
picked up and left the children at their homes.

We did not have facilities to take care of half the
children who came to us and who could have derived benefit from the program,
even though we had adopted rigid principles of selection. The patients were
carefully chosen, and none showing marked mental deterioration or progressive
disturbances were admitted to the class. Psychological tests were made –
various types being used because of the wide variety of handicaps which were
encountered – and where the intelligence quotient was above 70, the child was
regarded as teachable. In some cases a high degree of intelligence was
revealed, although seemingly the child was mentally retarded. Sometimes
psychiatric and sociological investigation revealed that home conditions were
responsible for the child’s failure to adjust to school life. More often the
explanation lay in some special disability, as in hearing, speaking, reading, or
writing. Care was exercised in differentiating between a special disability and
a deficiency. There is no treatment for the latter, while the former can often
be overcome under special training. The child, who is good in arithmetic but
poor in reading, or vice versa, suffers from a special disability. The child
who does poorly in both is probably mentally defective. And, finally, we
accepted only cases in which there seemed to be a good chance that treatment
would enable them eventually to take a place in the normal education system.

The Board of Education arranged for a showing of education
films at the school once a week. I was particularly interested in the reaction
of the children to the performance. They became so completely absorbed in what
they saw on the screen that all involuntary movements ceased, and for the
duration of the performance they appeared perfectly normal. This observation
furnished a clew to the principle that visual education is more important than
any other form of training for the spastic.

I found further support for this conclusion in one of Dr.
McGraw’s observations on the behavior of the normal infant. In the case of a
child just beginning to extend his arms to reach for an object in the visual
field, she found that if the sight of the object is excessively stimulating, the
energy which should be directed toward extension of the arm in the direction of
the object becomes converted into disorganized general body activity. Too
little interest in the object would fail to stimulate movement in the direction
of the object, and too much interest would interfere with the child’s control
over the motor activity involved. I made a related observation in the case of a
spastic athetoid patient who was given blocks to pile up on a table. He placed
the first one on the table with only slight athetosis. The placing of the
second block on the first involved an increased amount of overflow activity,
which was further augmented when the third was placed on the second. The fourth
could not be placed at all, and the whole pile was knocked down. The process
was repeated several times with similar results. Then the patient was equipped
with pin-point blinders, such as are used in the treatment of cataract, which
cut down his vision to the blocks and a small part of the table. He was then
able to place the blocks on top of one another more successfully and with less
overflow activity.

In further experiments I found that the cutting down of
excess stimuli from the various sense organs brought about an improvement in
motor control. In the schoolroom various means were used to concentrate the
pupil’s attention on the task in hand. As he projected himself more and more
into his work and forgot himself and his difficulties, there was a very
noticeable improvement in the quality and quantity of his work, and also in
physical control. One boy was so handicapped that he was constantly sliding off
his chair onto the floor. Yet when this same boy was told to correct the
arithmetic problems of the other pupils, he kept his seat without difficulty for
long periods of time. Children with a speech handicap were asked to give
dictation to the other pupils, and they became so engrossed in the assigned task
that they forgot their difficulty and spoke more easily. Typewriters,
particularly the electric model which requires practically no muscular effort to
operate, proved invaluable in the schoolwork. For some, who could neither write
with a pencil nor speak, they provided the sole means of expression. For those
who wrote very slowly and laboriously, they brought about a great improvement in
the quality of written work. The hand and eye coordination achieved by the use
of the typewriter cuts down the number of stimuli, and the resulting
concentration is reflected in better work. A teacher whom I had engaged to
tutor a private group of spastic children furnished the clew that lip-reading
was valuable even with those children who had no impairment of hearing. I was
unaware of her deafness when I engaged her. When I commented on the attentive
behavior of the children while she was conducting the class, she told me that
she was stone deaf and that the children had been told to look at her when
reciting, so that she could read their lips. The children became interested in
lip-reading and learned it as a game. Concentration on the speaker’s lips
reduced their overflow muscular movements, and also through imitation they
acquired better articulation.

Practically all the children in the school at the Institute
had speech defects. The disturbance was part of the general condition, and
often cleared up as the child acquired better control of his muscles, without
special emphasis being placed on speech training. There were various devices
which we used when this improvement did not occur. Many spastics speak while
inhaling instead of while exhaling, as the normal person does. Talking before
alighted candle and keeping the flames slanted away instead of toward the
patient served to overcome this fault. Talking while writing was found useful
in lessening the tension of the muscles used in articulation. The normal person
who suffers from stage fright finds similar relief by making gestures while
talking. Since the spastic has a tendency to hold his breath during moments of
conscious effort, exercises that improved the rhythm of respiration aided speech
by reducing the general muscular tension. Tongue exercises in front of mirrors
were occasionally given, but they tended to make the child too speech
conscious. The spastic’s speech difficulties are often the result of trying too
hard to talk. I learned a way to overcome this difficulty when I made my first
radio talk. The announcer told me to speak just above a whisper without a
strain. Friends who heard the broadcast said that they had never heard me talk
more distinctly. So I adopted the use of microphones and loud-speakers for
speech training, and found that the spastic soon acquires the correct
articulation patterns when he can make himself understood with a minimum of
effort. The mirror phone, a recent invention that reflects the voice and
enables the spastic to hear the words he has spoken, is valuable in teaching
correct enunciation.

The educational program of the school at the Institute was
not designed to give the children as much as they could absorb without
discomfort or merely to keep them occupied, but rather to develop concentration,
perseverance, and the ability to do hard work. Basically it aims were to help
the handicapped individual to make a healthy adjustment to his condition, and to
open the way to a purposeful and useful life. Too frequently parents and
teachers make special concessions to the spastic because of his handicap. I
know of one case in which a boy completed his school and went to college for
four years, but was never required to take an examination, although he was
perfectly capable of writing. His actual academic grade, as revealed by careful
tests, was well below the college level. He lacked the proper training to
secure employment and to do a job well, and since he was in the habit of having
concessions made because of his handicap, he developed into a behavior problem
when confronted with normal standards. It is mistaken kindness to adopt
unrealistic standards in educating the spastic, particularly considering the
remarkable improvement often shown when the child is held to a rigid routine.
An illustration is furnished by the case of a considerably handicapped boy of
twelve. At home he had received instruction from a tutor for two-hour periods
three times a week. He admitted that these periods were frequently cut to as
little as fifteen minutes by his complaining of fatigue or headache. After
attending a special school for a year this boy had no trouble in going to school
from 9 A.M. to 3:30 P.M. and in spending two to three hours more on homework
everyday. He learned to feed himself, partially dress himself, and even would
attempt to walk upstairs alone.

There were so many instances of remarkable improvement
under our scheme of simultaneous mental and physical training, and so much
interest in the work of the clinic was shown, that the need for more space
became acute. It was Miss Esther F. Rivington, superintendent of the Institute,
who came to the rescue. She induced a philanthropic friend to give a sum
sufficient to convert the basement of the Neurological Institute, which had
previously been used as servants’ quarters, into a home for our clinic, with a
special entrance on Fort Washington Avenue, so that the patients did not have to
come through the regular hospital entrance. Here we had seven rooms, which gave
us the first really adequate facilities for our work. There was a railed ramp
to the door from the street entrance, so that ambulatory patients could come in
without assistance; a hall-waiting room, an office for the clinic secretary, and
office for myself, the schoolroom, and four rooms for physical therapy. We had
four full-time therapists on the staff, and were able to do far more for the
cases that came to us than ever before. As a result of the attention given to
the clinic in the press, children were brought to us from great distances for
examination and treatment. In many cases, of course, and examination revealed
that the child couldn’t be helped by our program; in others, though the child
could benefit from training, it was financially impossible for the parents to
leave him at the Institute. In such cases I advised the parents to go home and
try to form a class for handicapped children under local auspices.

A father brought his boy to me all the way from Port
Arthur, Texas, in a dilapidated car. He told me that he could not afford to
stay in New York while the boy received treatment, but that he wanted my opinion
on the case. After examining the child and finding that he could benefit from
treatment, I had a talk with the father. I suggested that he find out if there
were enough spastics to justify starting a special class in his home town, then
get in touch with the board of education and the societies interested in
crippled children, and that I would be glad to come down and explain our methods
if the community was willing to co-operate. He seemed doubtful that there would
be enough handicapped children to justify such arrangements, but shortly after
he got home, he discovered fourteen in Port Arthur alone. He enlisted the aid
of the board of education to supply the services of a teacher, and of the
Crippled Children’s Society to furnish a therapist. St. Mary’s Hospital
supplied space for a clinic, for which almost a hundred spastic children
registered. I went down to conduct the clinic and to deliver several lectures
on the spastic problem, using moving pictures to illustrate the methods of
treatment used at the Institute in New York. Shortly afterward, classes were
started, and eventually the school was established in a building of its own. In
a similar way, special schools modeled on that at the Institute were established
in Birmingham, Alabama; Sharon, Pennsylvania; San Francisco; and other places.

A summer spent as medical advisor to a camp for handicapped
children suggested a way of increasing the benefits of special education for the
spastic. I found that the children at the camp obtained more benefit from
physical therapy and educational work than those at the hospital, because these
activities were coupled with natural play and outdoor life. The physical,
mental, and emotional improvement of these children was so marked that I decided
that a regular school for spastics should be established in the country.
Running a school was really no part of a hospital’s work, yet education was a
vital part of the treatment for the spastic. There were many cases in which a
long period of special training was demanded by the seriousness of the handicap,
and we had been unable to accept these at the Institute because of our limited
facilities. I also felt that a country boarding school would enable handicapped
children to forget to think of themselves as patients and make it easier for
them to develop their potential social usefulness. At a boarding school the
children would have no opportunity to lose what they had gained in
self-discipline from a combined mental and physical training program during the
day by being spoiled when they returned home at night. From observing the
children at the cam, I anticipated that many cases would show startling
improvement when disturbing home influences were removed, and that they would be
free from nervous tension and emotional strain once they settled down to the
regular routine of life in a boarding school. At first the idea of such a
school seemed something of a dream and then I decided that I had found the
person to help me make my dream a reality.

While I was laid up in the hospital with a bad cold, I
became interested in one of the nurses who took care of me. This Miss Schneider
had a ring in her voice that made me forget that I was sick, and her cheery way
appealed to me. Every morning when she came in to take my temperature and
pulse, she would tell me how much better I was; that yesterday my hand had
shaken so much that she could hardly take my pulse, while today it was steady.
What had happened was she had made me forget myself, and consequently there had
been the usual improvement in my physical control. We had a number of talks,
and I told her that she would make a good supervisor for the spastic children in
the clinic, since she had this ability to make patients forget themselves and
their troubles. I made her promise to look over the clinic when I was back on
the job again. We became good friends, and one day she asked if she might take
a private call on the phone in my room. I consented, of course, and though she
talked in German, I could gather that she was making a date with somebody. When
she hung up, I promptly asked her when she would make a date with me. I got
scolded for eavesdropping, but I did get that date once I was well again.

Ilse Schneider had a car, and we made many excursions in
it. I forgot myself in the excitement of going out with a pretty girl, and felt
more poised than ever before. She was interested in my work, and I talked over
with her the cases I had examined during the day. Usually we had these talks
over smorgasbord in a Swedish restaurant, where the atmosphere and the food
reminded me of home. I was fond of having a bottle of wine with my dinner, and
Ilse noticed that I seemed to have better control over my hands after drinking
the first glass. She asked whether she or the wine had a steadying effect on
me, and I replied- both tactfully and truly- that it was a little of both.

As a result of the interest that was aroused by the
Institute school, I began to receive requests to address various groups and tell
them about its program. There was no question in my mind that it was important
to bring the spastic problem before the public, but I did not feel that I, with
my handicaps, was the person to do it. The idea of getting up on my feet before
a large audience filled me with dread, for I remembered all too vividly how I
had become tongue-tied with embarrassment when called upon to recite in class at
school and college. Now I felt at ease in small groups, and even when there
were many strangers present; but public speaking was another matter entirely. I
talked over this problem with Ilse and she urged me to make an attempt at it,
since it would help the work so much. Reluctantly I accepted an invitation to
speak at a national conference on social work in Philadelphia.

For weeks beforehand I could not sleep, so much did I dread
the prospect. I thought of developing a convenient illness which would provide
an excuse for not going through with the arrangement, as all my past
difficulties in public passed and repassed through my mind. But Ilse told me
that I had no choice in the matter, now that I had accepted the invitation, and
I went over the Philadelphia feeling more dead than alive. As I awaited my turn
to speak, I began to tremble. The audience seemed perfectly enormous, and I
could imagine no possibility that they would listen to my fumbling attempts at a
speech. I tried to concentrate on the few familiar faces I saw there, but I
could not calm myself in this way. Then I remembered my old trick of taking off
my glasses, so that my field of vision was arrowed down to the platform on which
I stood. This device worked, and my talk went better than I had ever dreamed it
could. I felt jubilant when the ordeal was over, and wired Ilse that all had
gone well. She met me at the station upon my return to New York, and we had
dinner together to celebrate the occasion.

As with many other activities, once that first speech was
made with some measure of success, I had less difficulty thereafter in public
speaking. Since then I had given an increasing number of talks to organizations
interested in the plight of the spastic. Each speech has made the next easier
to make, just as the first few steps on a slippery pavement made it possible for
me to walk without the constant fear of tumbling down. But just before I give a
talk, I still feel a little bit as Mark Twain did when he began his career as a
lecturer. He appeared upon the platform white, trembling, perspiring freely,
and barely able to utter these opening words: “Julius Caesar is dead; Napoleon
is dead; and I am far from well.” Like him, I always try to let the audience
know my deficiencies as a speaker, before I settle down to the subject of my
address, which makes matters easier for both my hearers and myself.

In my talks with Ilse I discussed my dream of establishing
a boarding school for spastics. She offered to help me start such a school and
to manage it for me. I left the problem of finding a suitable place to her, and
she discovered a house in New Rochelle that seemed ideal for our purpose. She
had far more confidence in our undertaking than I had, and it could not have
been carried through without her. I had to give a lecture in Chicago on the day
set for the opening of the school, and on my way out there and back I had
wretched time regretting my foolhardiness. Upon my return, however, I found
that we had got off to a good start. The school flourished from the beginning,
and its success was due in large measure to Ilse’s efforts.

During that first year of the school’s life, I asked Ilse
to marry me. I know that in her I had found the perfect partner for the life I
wanted to lead, and I was overjoyed when she accepted me. The wedding date was
set for her birthday, and on the day before we obtained a marriage license from
the city hall. Since I had no sectarian religious convictions, I suggested that
we be married by the magistrate. But Ilse was a minister’s daughter, and she
insisted on being married by a minister. This raised something of a problem for
me, since I know no clergyman whom I could ask to officiate. The difficulty was
solved in a curious way. When we returned to the school from the city hall, the
head nurse told me that a Dr. MacGregor wanted to be shown over the school. I
took him around, using medical terms to describe the handicaps of the children,
and he seemed very much interested. But just before he left, he asked what some
of these terms meant in everyday language. When I sputtered, “But aren’t you a
doctor?” He explained that he was a doctor of divinity, not of medicine. I
told him he was just the man I wanted, and asked him to marry us the next day.
So we were married in his rectory, with my old friend Harold as best man.

In excursions to the shore at New Rochelle, we found that
many of the children whose ability to walk was retarded by fear of falling did
very much better on the beach, when they realized that they could not hurt
themselves if they tumbled on the sand. They also derived so much benefit from
playing out of doors that we wished it were possible for them to do so all the
year round. One of the parents suggested, that we conduct the school in Florida
during the winter, where the climate made that possible. It did not take much
persuasion to make me fall in with this idea, for I had not lost my childhood
desire to avoid snow and ice and their terrors for the spastic by spending my
winters in the South. We decided to test the scheme, and opened a small school
in Miami Beach. My wife took charge of the new establishment, while I
supervised the New Rochelle school and commuted between New York and Florida.
It was the custom at the Institute for members of the staff to take their
vacations during the summer, since many of them gave courses in the medical
school during the academic year; but I arranged to take mine piecemeal during
the winter in these trips to Florida. The children derived so much benefit form
the sun and sea in Miami, and we had so much less trouble with the colds which
are more serious for the spastic than the normal person, that we decided to
bring our northern school south each winter in the future. Eventually our
school, which now provides training from the nursery level through high school,
was established in permanent homes by the sea during the summer at East Hampton,
Long Island, and during the winter at Pompano, Florida where the children lead
an outdoor life all the year round, with the same program of mental and physical
training and recreation.

I had a curious and moving experience when I was invited to
Minneapolis to conduct a clinic at the University Hospital where I had been
examined as a child. I felt a little bit like Rip van Winkle returning to the
scenes of his youth. When I had come to the hospital as a patient, I had been
examined in a small building which was quite adequate for the purposes of the
clinic at that time. Now there was a great medical center, covering scores of
acres, which possessed the most modern equipment and afforded all the resources
that medical progress had made possible. In my own field of neurology, however,
there had been pitifully little advance in the understanding and treatment of
disorders, although they were recognized to be increasing.

The night before the clinic I gave a lecture to the
Minnesota Association for Crippled Children, and shoed movies which illustrated
the methods of treatment used at the Institute. I was introduced by the same
Oscar Sullivan who had helped me to obtain an education at the University, and
he made much of the contrast between my coming to him twenty years before to ask
for funds for textbooks and instruments and my return as a specialist in helping
the spastic. He pointed me out as an example of what the handicapped person
could do if he determined to help himself. Yet the next day, when I went over
to the University to conduct the clinic, I was mistaken by a campus policeman
for a patient and instructed to get in line with the adults and children who
were waiting to be examined. So it was through the patient’s entrance that I
returned to the University clinic.

When I was recognized by the other doctors and introduced
in my role of specialist, the patients were delighted by what had happened. I
took advantage of the occasion to read a little sermon. I told how I had come
twenty years before to be examined at the neurological clinic, and my mother had
been advised that there was no hope for me physically, though I could benefit
from education. The diagnosis was so correct that I had returned as a physician
and had been mistaken for a patient. I supposed that a great many of those who
came to the clinic hoped, as I had hoped, to be told of some miraculous cure for
spastic paralysis. But I had to echo as a physician what I had been told as a
patient. In education and in self-discipline lay the greatest hope of
overcoming the handicap. Surgery and physical therapy could help the spastic to
better control of his disordered nervous system, but they could not cure it. The
spastic must not live in the false hope of getting completely well, with all his
attention centered on physical improvement. He must accept the fact of his
limitations, and develop his potentialities as fully as possible within the
limits set by the nature of his handicap. And finally I warned the patients
that too much attention to treatment might hamper the natural development of
their abilities.

In my practice I encountered a case which provided an
excellent illustration of the foolishness f living in hope of a cure by special
treatment, and of ignoring the possibility of natural development. It was a boy
of good intelligence who was unable to walk or talk. His parents, who were
wealthy, provided him with a corps of specialists; a private physical trainer, a
private tutor, a private speech trainer, and a private nurse. The efforts of al
these therapists showed no evident results over a long period of time. Then one
day when the family was away, the chauffeur took the boy over to his cottage to
watch his children play football. The boy wanted to join the game, and he was
given a helmet to wear. He took a few steps and fell down, but the helmet saved
him from hurting his head when he fell. So he tried again, and his interest in
joining the other children in their game soon enabled him to walk without
falling. All the therapy he had received had doubtless helped to make walking
possible for him, but the uncoordinated program of training had hampered his
natural development and had not given him the desire to overcome his handicap
which the competition with the other children provided.

The overemphasis placed by most parents on the physical
improvement of the handicapped child always brings to my mind the case of the
spastic horse. I was asked by the owner of a string of race horses to examine a
birth-injured cold which had been bred from very valuable stock, and to see
whether anything could be done to help it. I found that the colt could not get
up by itself, and that when it had been placed on its feet, it could not decide
where to go and wandered aimlessly.

When it saw its mother, however it would follow her and
imitate her actions. I suggested using blinders, which by cutting down the
visual stimuli brought about a great improvement in the colt’s sense of
direction. The owner asked me whether a complete cure might be hoped for, but I
had to tell him that, while improvement might be expected with growth, the colt
could never become a race horse. As this became evident after a few moths, the
owner had the animal shot. In the animal only the physical abilities are
important. But with the human being the intelligence can be developed by
training to overcome the physical inadequacy, and it is a great mistake to treat
the spastic child as though he were an animal rather than a human being.

Yet frequently the right of the spastic to education is
questioned, though it is only through education that he has a chance of becoming
socially useful, instead of a burden on society. All spastics, of course,
cannot benefit to the same degree from an educational program. The severely and
hopelessly handicapped no doubt must be institutionalized. They should not be
treated as idiots, however, receiving only custodial care; ways must be found to
keep their brains busy, in order that they may develop mentally as much as they
can. Others whose physical handicap is not too sever, although their low-grade
mentality prevents them from benefiting from education beyond the lower grades,
just be guided into routine occupations whose duties they can perform adequately
despite their limitations. Those with good intelligence should not be barred
from obtaining as much educational training as they can benefit from, even
though their physical handicaps are of such a nature as to close many vocational
avenues which are open to the normal person.

Much can be done for the spastic child if his parents can
be made to realize that the problem is not an individual one and that
cooperation with others is the best approach to it. Recently I received letter
from Brazil, asking whether I could come to Rio de Janeiro to examine a patient
or whether it would be necessary to bring the child to me in New York. Since I
had received similar requests from a number of other South and Central American
countries, I replied that I should be glad to simply for my expenses and
suggested that I would get in touch with my other correspondents so that the
financial burden might be shared. So it came about that my wife and I traveled
twenty thousand miles by plane and visited sixteen countries in one month. We
flew down the west coast of South America and up the east coast. After leaving
the La Guardia Airport in New York in the evening on a sleeper plane we awoke
the next morning in Brownsville, Texas. From there we went to Mexico City for a
three-day stay. Other stops included Guatemala City, Cristobal, Cali, Lima,
Santiago, and Buenos Aires, where we spent four days. Then we went to Rio de
Janeiro, for five days, visiting Sao Paulo, Asuncion, and Igazu Falls while en
route. We then flew to Belem, Trinidad, San Juan, and Miami, arriving in New
York City again on the thirtieth day of the air cruise.

Wherever it was possible, I held clinics and talked to
medical groups, using movies to illustrate methods of helping the spastic to
find himself. Since I do not speak Spanish or Portuguese, my wife often had to
translate my talks into French or German where English was not generally
understood. In the past, many South American doctors were trained in France or
Germany and the well-to-do South American was more likely to consult a Paris or
Berlin specialist than a compatriot. Recently there has been a growing tendency
to look to the United States for medical leadership.

In the surgical approaches to the spastic problem, the
South Americans had nothing to learn; but educational therapy was entirely
neglected. This did not surprise me, since less than a score of our states make
any provision for the education of non-ambulatory cripples. I found that
excellent institutions existed for the care of the feeble-minded, and that they
were given as much education as they could absorb and were encouraged to find
useful occupations. I urged my audiences to do as much for the spastic, and not
to keep him buried in the seclusion of the home. Since the sense of shame about
having an abnormal child is less intense and lasting in Latin America than in
this country, I found it easier to induce the parents of afflicted children to
start special schools.

The trip was one of the most enjoyable in our lives.
Everyone was kindness itself, and we were overwhelmed with hospitality. I have
always enjoyed air travel, for the altitude up to 10,000 feet improves my
physical control. When we went up to 21,000 feet in crossing the Andes from
Santiago to Buenos Aires and were given oxygen tubes to use in case the rarefied
atmosphere induced faintness, I found that eh increased oxygen intake brought
about a miraculous improvement in my steadiness of hand. The experience
provided another illustration of the importance of correct breathing for the
spastic. I trust that my ability to make the trip served to convince my South
American friends that eh spastic can become self-dependent if given educational
opportunities and that schools should be provided for him.

The role of these special schools is not confined to
helping children to develop as fully as possible within the limits of their
handicap. There have been many instances in which the example furnished by the
children has helped adults to overcome their handicaps. A man who was unable to
walk although he could maintain his balance, as a result of a stroke, came to my
school in Florida and insisted on my prescribing treatment for him, though I
told him that I confined my work to children. He was disgruntled when I
suggested a system of exercises, and he dismissed them as being just the same
sort of treatment as he had undergone for months without deriving any benefit.
But is wife insisted on his going through with them, and he came to the school
regularly to do his exercises under the supervision of one of my physical
trainers. When he saw some of the children, who were far more handicapped than
he, making light of their difficulties, he forgot his own troubles. He became
particularly interested in one child, and told me that he wanted to finance his
way through school. In a few weeks he was walking without assistance. He could
have benefited just as much from similar treatment elsewhere if it had not been
for his preoccupation with his difficulties. As soon as he saw that those more
seriously handicapped than himself were making better progress, he realized that
he could get well, and did.

The great unsolved aspect of the spastic problem is the
question of vocations. And since the sense of personal worth obtained by being
economically self-dependent and socially useful is the best medicine for the
spastic, often bringing about the most remarkable physical improvement, too much
attention cannot be devoted to finding suitable vocations. In all programs of
training and education for the spastic, the goal should be not merely getting
well but becoming socially useful. We do not feel sorry for the blind beggar
because he cannot see, but rather because he has to beg. The plight of the
spastic will be less pitiful as more means are found of making him a
self-dependent member of society.

The solution of the spastic’s vocational problem is
dependent upon many factors. One of the most important is his own attitude
toward his handicap. As a small child the intelligent spastic is happy, no
matter how seriously he may be afflicted. The normal person feels sorry for
him, and cannot understand his happiness. But he has been “born that way,” and
is as yet unaware that others are free from the physical afflictions which have
always been his. As he grows older and becomes more self-conscious, there is
serious danger of his becoming a social misfit unless he receives careful
guidance. During adolescence the child is likely to develop a morbid attitude
toward his handicap if he finds that it stands in the way of realizing his
ambition. A young man whose one ambition was to become an airplane pilot lost
all interest in his studies when he realized that his physical condition could
not be improved sufficiently to make that career possible. But usually it is
possible to divert the spastic’s interest into related fields where his handicap
will not be an insuperable barrier. In this case the young man was induced to
take up shop work with the view of becoming an airplane mechanic. His
successful progress in this field gave him the assurance and self-confidence
necessary to further physical improvement.

If the spastic is unable to face the world of reality
despite his shortcomings, he falls into despair, and his only desire is to live
apart from society in a world of his own. The usual result is mental and
physical deterioration, or at best an unhealthy attitude toward life. The
special school can save the spastic from developing into a social misfit by
teaching him to accept his handicap and to find some means of compensating for
it. Once the sense of personal worth is established by competition with other
handicapped children, the individual can usually take his place in normal
society. But if the spastic is deprived of these opportunities, a less
fortunate development may take place. I know of a young man of high
intelligence and good speech, who could not walk or use his hands and therefore
was not put in school. His wealthy parents gave him every attention, but he was
conscious of being kept out of sight and of being ostracized from normal
society. His brooding over his plight made him sympathetic to the social
underdog and he became a Communist, devoting his intellectual energies to
attempting to bring about the downfall of the society in which he had found no
place.

On the other hand, I know of a young man who had fewer
advantages and made a much better use of his opportunities. He came to me for
vocational advice while he was in college. He had his heart set on becoming a
lawyer, although this ambition was opposed by his parents, who felt that he
could never hope to practice law because of his physical handicaps and that the
expense of his professional training was unjustified when money was needed for
the education of his un-handicapped brothers and sisters. He overcame their
objections, however, and succeeded in taking his degree at law school. He found
it difficult to obtain employment in the field for which he was trained, though
all the prospective employers who interviewed him congratulated him on his
achievement and regretted that they had no job for him. Knowing of President
Roosevelt’s interest in the handicapped, he wrote him an account of his
difficulties and received a cordial reply. He went to Washington and saw the
President, and with his aid obtained a position doing legal research for a
government agency. He has been so successful in his chosen career that he is
able to help put his brothers and sisters through college.

There is almost always a way of circumventing the handicap
is the spastic’s ambition is reasonable in the light of the extent and nature of
his difficulties. The spastic’s success or failure in life is not dependent
upon his physical development. I know of one man who was physically unable to
write. He made a success in business and employs several secretaries to do his
writing. A spastic who wanted to be a geologist, though unable to do extensive
field work, became a successful geological librarian. A girl who had won a
college degree, finding that the presence of strangers brought on nervous
tension which accentuated her physical difficulties, made a career for herself
as a teacher of the blind. Freed of the sense of being the object of curious
observation, she forgot her difficulties and evidenced remarkable physical
improvement. One patient who was affected only in the legs has done well as a
plumber. One severely handicapped spastic earns his living by devising
crossword puzzles for the newspapers and writing radio scripts. Another is a
copywriter in an advertising agency. A third teaches in a university, where his
lectures are so popular that they are attended by many students not taking his
course. Still another has made a reputation as a photographer.

There is no question that the spastic has a hard row to hoe
in the matter of finding employment. Lack of understanding on the part of the
general public is in large measure responsible for the fact that less than a
hundred of the more than eight thousand patients whom I have tried to help have
made a completely satisfactory adjustment to society. It is not that they lack
ability, but that they have so much trouble in getting an opportunity to
exercise their ability. The spastic child is cute an appealing and arouses the
sympathy of the normal person. The spastic adult is not appealing and meets a
less fortunate reception. Those whose handicaps are less severe may succeed in
obtaining employment, but have difficulty in keeping the job once they get it.

Frequently the spastic’s thought processes are as
hyperactive as his muscles, and he has a tendency to fly off the handle on
slight provocation. The average employer, no matter how kindly disposed, cannot
tolerate such behavior. He dispenses with the services of the individual in
question and forms a prejudice against hiring another spastic. The spastic’s
lack of self-discipline may take another form: he may become sulky and
dissatisfied when he discovers that in real life praise is not awarded for every
act that he performs successfully. I now of one spastic who became a successful
theatrical director because he could impart to normal people the lessons in
self-control which had helped him to overcome his affliction.

The spastic’s success or failure in meeting the vocational
problem is not dependent upon the extent of his handicap. The same factors of
personality and temperament which play a part in the case of the normal
individual also operate in the case of the spastic. The highly sensitive,
introvert type may never escape from brooding over his difficulties, which seem
insurmountable barriers between him and the rest of the world. This is
particularly likely the case with an only child who is not forced to do as much
as he can for himself, who is kept from school and deprived of the companionship
of his contemporaries, and thus falls into the habit of living completely within
himself. If there are other children in the family he has to struggle for his
rights, so much the better for him. I know a boy of this extrovert type who, in
spite of his unsightly appearance, ungainly gait, and a severe speech
difficulty, did not hesitate to take on a door-to-door selling job. When he
lost his job because of complaints to the company about his appearance, he
worked his way over to Europe on a cattle boat. He found work as a manual
laborer where his appearance did not matter, married, and had children. His
nature and environment enabled him to become a useful member of society in spite
of his handicaps, and in the process he improved his physical condition
tremendously.

A sense of humor is an exceedingly valuable asset for the
spastic. If he can laugh at the embarrassing incidents in which his physical
handicaps involve him and dismiss them jokingly, he can save himself from the
crippling effects of fear, anxiety, and self-consciousness. Those of us who are
concerned with the training and education of the spastic try to develop a sense
of personal worth by every means of our power. I have seen it acquired slowly
through years of education and destroyed in a few weeks or months when the
spastic found employer after employer unwilling to give him a chance to use the
ability he had so painfully developed. If it is completely destroyed, there is
a distinct danger of suicidal impulses developing. Even part-time jobs can make
the spastic feel that he has a place in the world.

Schools that I have helped to establish have been built up
around a child so hopelessly handicapped that there was little hop of restoring
him to an approximately normal condition by treatment. In know of one family
which had no financial worries but came to feel that life was not worth living
because they could not find any doctor who would promise that their spastic
child could be restored to health. In the fruitless search for a cure, a once
happy marriage had reached the point where the husband and wife were thinking of
committing suicide and taking the child with them. An examination disclosed
that the child was intelligent, though helplessly crippled, and I told them that
they had made their problem too self-centered. I suggested that they organize a
nursery-school group in which their child and other handicapped children could
receive education and treatment. Since the parents were not willing to have
their neighbors know that they had a spastic child, they showed reluctance in
accepting my scheme. Finally they adopted it, and their interest in the
progress of their own child and in that of the others in the school made them
feel that life was worth living.

Every human life has its purpose, and even the most
hopelessly handicapped can be useful to society.

I have sometimes been embarrassed by being hailed as an
example of what the handicapped person can to if he determines to overcome his
difficulties. But what I have accomplished is really due to the help and
guidance, throughout my life, of a host of teachers and friends. They kept me
struggling against my difficulties and encouraged my belief that, by making the
most of my opportunities, I could help other spastics to free themselves from
the shackles of their handicap and become useful citizens.